Provider Demographics
NPI:1639399769
Name:GANGULI, SUDHA NIMMAGADDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:NIMMAGADDA
Last Name:GANGULI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUDHA
Other - Middle Name:N
Other - Last Name:GANGULI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:388 S PAULINE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6219
Mailing Address - Country:US
Mailing Address - Phone:901-525-0278
Mailing Address - Fax:901-526-9014
Practice Address - Street 1:388 S PAULINE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6219
Practice Address - Country:US
Practice Address - Phone:901-525-0278
Practice Address - Fax:901-526-9014
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist