Provider Demographics
NPI:1003816893
Name:ADIGA, SUCHETHA (MD)
Entity Type:Individual
Prefix:
First Name:SUCHETHA
Middle Name:
Last Name:ADIGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUCHETHA
Other - Middle Name:
Other - Last Name:SOANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7040
Practice Address - Street 1:2374 E PACIFICA PL
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-6214
Practice Address - Country:US
Practice Address - Phone:310-225-3244
Practice Address - Fax:310-698-7040
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160356207ZC0500X, 207ZP0102X
PAMD064674L207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19549Medicare UPIN