Provider Demographics
NPI:1821019803
Name:SURA, ASHWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:
Last Name:SURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 BRITTANY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9144
Mailing Address - Country:US
Mailing Address - Phone:225-767-0460
Mailing Address - Fax:225-767-3262
Practice Address - Street 1:5425 BRITTANY DR
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9144
Practice Address - Country:US
Practice Address - Phone:225-767-0460
Practice Address - Fax:225-767-3262
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07322R174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA37338OtherBLUE CROSS BLUE SHIELD
LA1371726Medicaid
LA37338OtherBLUE CROSS BLUE SHIELD
B64901Medicare UPIN