MEDICARE: SRINIVAS REDDY CHITTI MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	L0085	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00734W	OTHER		MEDICARE

General Provider Information

NPI Number	:	1891796892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRINIVAS REDDY CHITTI MD PA

Provider Business Mailing Address
First Line	:	10501 VISTA DEL SOL DR
Second Line	:	SUITE 210
City	:	EL PASO
State	:	TX
Zip	:	79925-7940
Country	:	US
Telephone Number	:	915-633-9317
Fax Number	:	915-633-8676

Provider Business Practice Location Address
First Line	:	10501 VISTA DEL SOL DR
Second Line	:	SUITE 210
City	:	EL PASO
State	:	TX
Zip	:	79925-7940
Country	:	US
Telephone Number	:	915-633-9317
Fax Number	:	915-633-8676

Authorized Official
Title or Position	:	OWNER
Name	:	SRINIVAS REDDY CHITTI
Credential	:	MD
Telephone Number	:	915-633-9317

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/14/2014

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