Provider Demographics
NPI:1295014389
Name:ALEXANDER P. SUDARSHAN MD PA
Entity Type:Organization
Organization Name:ALEXANDER P. SUDARSHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:PRADIP
Authorized Official - Last Name:SUDARSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-4828
Mailing Address - Street 1:1058 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9988
Mailing Address - Country:US
Mailing Address - Phone:956-541-4828
Mailing Address - Fax:956-541-4568
Practice Address - Street 1:1058 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9988
Practice Address - Country:US
Practice Address - Phone:956-541-4828
Practice Address - Fax:956-541-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6901TG152W00000X
TX3479TG152W00000X
TXG5668207W00000X
TXJ6751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286292201Medicaid