Provider Demographics
NPI:1679168546
Name:DEEPTHI PARVATANENI MD PA
Entity type:Organization
Organization Name:DEEPTHI PARVATANENI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DEEPTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVATANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-645-3798
Mailing Address - Street 1:PO BOX 16524
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-0524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6913 CAMP BOWIE BLVD STE 171
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7165
Practice Address - Country:US
Practice Address - Phone:817-731-6121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730473935OtherNPI