Provider Demographics
NPI:1508240722
Name:SALAGUNDLA, NETHUJA (MD)
Entity Type:Individual
Prefix:
First Name:NETHUJA
Middle Name:
Last Name:SALAGUNDLA
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 1:900 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3902
Mailing Address - Country:US
Mailing Address - Phone:817-336-2100
Mailing Address - Fax:
Practice Address - Street 1:2390 WEST CONGRESS STREET
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-261-6000
Practice Address - Fax:337-261-6003
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310727207R00000X
TXS9791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine