Basic Information
| Provider Information | |||||||||
| NPI: | 1578784435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODAVARI | ||||||||
| FirstName: | ANURADHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHINTAKINDI | ||||||||
| OtherFirstName: | ANURADHA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1300 W TERRELL AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178204906 | ||||||||
| FaxNumber: | 8178204815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W TERRELL AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178204906 | ||||||||
| FaxNumber: | 8178204815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 04/16/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2005011334 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | P1313 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.