Provider Demographics
NPI:1073599007
Name:NALAGATLA, SUCHARITHA (MD)
Entity Type:Individual
Prefix:
First Name:SUCHARITHA
Middle Name:
Last Name:NALAGATLA
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 1:2275 MILLVILLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-4248
Mailing Address - Country:US
Mailing Address - Phone:513-892-3086
Mailing Address - Fax:513-892-3789
Practice Address - Street 1:2275 MILLVILLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-4248
Practice Address - Country:US
Practice Address - Phone:513-892-3086
Practice Address - Fax:513-892-3789
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00210531OtherRR MEDICARE
OH207169Medicaid
OH000000361852OtherANTHEM
OHNA0861214Medicare PIN
OH000000361852OtherANTHEM