Provider Demographics
NPI:1326061342
Name:SAMALA, SUJANA (MD)
Entity Type:Individual
Prefix:
First Name:SUJANA
Middle Name:
Last Name:SAMALA
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 1:1000 CRESCENT GREEN DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8116
Mailing Address - Country:US
Mailing Address - Phone:919-816-4948
Mailing Address - Fax:919-233-7685
Practice Address - Street 1:1000 CRESCENT GREEN DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8116
Practice Address - Country:US
Practice Address - Phone:919-816-4948
Practice Address - Fax:919-233-7685
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400254207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1424NOtherBCBS OF NC
NC191320OtherMEDCOST
NC5904394Medicaid
NC1424NOtherBCBS OF NC
I59234Medicare UPIN