Provider Demographics
NPI:1548370893
Name:MEDARAMETLA, SUJATHA (MD)
Entity type:Individual
Prefix:
First Name:SUJATHA
Middle Name:
Last Name:MEDARAMETLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 AMBERTON PKWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2197
Mailing Address - Country:US
Mailing Address - Phone:214-570-3188
Mailing Address - Fax:214-570-3165
Practice Address - Street 1:9330 AMBERTON PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2197
Practice Address - Country:US
Practice Address - Phone:214-570-3188
Practice Address - Fax:214-570-3165
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85863207R00000X
TXN0267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200441803Medicaid
TX200441806Medicaid
TX200441801Medicaid
TX200441802Medicaid
TX200441804Medicaid
TXTXB121732Medicare PIN
TX8L9108Medicare PIN
TX200441803Medicaid
TX200441801Medicaid
TX8L9107Medicare PIN
TXTXB121845Medicare PIN
TX200441806Medicaid