Provider Demographics
NPI:1609229947
Name:SANTHANAM, PRATHIPA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHIPA
Middle Name:
Last Name:SANTHANAM
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8200 CONSTANTIN BLVD FL 4
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3481
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-765-2054
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019017842080P0206X
390200000X
LA3321742080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty