Provider Demographics
NPI:1215040779
Name:AGUSALA, PRATAP (MD)
Entity Type:Individual
Prefix:
First Name:PRATAP
Middle Name:
Last Name:AGUSALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11111 JONES RD
Mailing Address - Street 2:BLDG 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6317
Mailing Address - Country:US
Mailing Address - Phone:281-890-4886
Mailing Address - Fax:281-890-6123
Practice Address - Street 1:11111 JONES RD
Practice Address - Street 2:BLDG 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6317
Practice Address - Country:US
Practice Address - Phone:281-890-4886
Practice Address - Fax:281-890-6123
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN8751207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease