Provider Demographics
NPI:1598847733
Name:SUGATHAN, PRASANNA (MD)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:
Last Name:SUGATHAN
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 1:501 DR. MICHAEL DEBAKEY DR.
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-312-8528
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:501 DR. MICHAEL DEBAKEY DR.
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-312-8281
Practice Address - Fax:337-497-1173
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD416983207RC0000X
TNMD024577207RC0000X
IAMD-42253207RC0000X
SD9384207RC0000X
NE28312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I066351Medicare PIN