Provider Demographics
NPI:1053356220
Name:DAYA, SAMANTAPUDI KRISHNAMARAJU (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTAPUDI
Middle Name:KRISHNAMARAJU
Last Name:DAYA
Suffix:
Gender:M
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:PO BOX 731912
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1912
Mailing Address - Country:US
Mailing Address - Phone:903-877-7777
Mailing Address - Fax:
Practice Address - Street 1:811 W INTERSTATE 20 STE 224
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5873
Practice Address - Country:US
Practice Address - Phone:817-641-6000
Practice Address - Fax:817-419-4501
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424649207RP1001X, 207R00000X, 207RG0300X
TXM9956207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI13575Medicare UPIN
PAP00310382Medicare PIN
PA082146FLTMedicare PIN
MD642582OtherCAREFIRST MD BCBS
PA1539339OtherGATEWAY-WMG
PA107943OtherJOHNS HOPKINS
PA1633674OtherHIGHMARK BLUE SHIELD
PA100443OtherGEISINGER
PAI13575Medicare UPIN
PA10109160Medicaid
PA2309064000OtherAMERIHEALTH 65 PA