Provider Demographics
NPI:1972560431
Name:CHITTALURU, NAGASUDHA (MD)
Entity type:Individual
Prefix:DR
First Name:NAGASUDHA
Middle Name:
Last Name:CHITTALURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUDHA
Other - Middle Name:NAGA
Other - Last Name:CHITTALURU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1111 HIGHWAY 6
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4914
Mailing Address - Country:US
Mailing Address - Phone:281-494-3460
Mailing Address - Fax:281-494-3463
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 130
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-494-3460
Practice Address - Fax:281-494-3463
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG80740Medicare UPIN