Provider Demographics
NPI:1821093196
Name:ALEXANDER PRADIP SUDARSHAN
Entity Type:Organization
Organization Name:ALEXANDER PRADIP SUDARSHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUDARSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-4828
Mailing Address - Street 1:1058 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9988
Mailing Address - Country:US
Mailing Address - Phone:956-541-4828
Mailing Address - Fax:956-541-4568
Practice Address - Street 1:1058 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9988
Practice Address - Country:US
Practice Address - Phone:956-541-4828
Practice Address - Fax:956-541-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5668207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109521801Medicaid
TX109521802Medicaid
TX00T49UMedicare ID - Type Unspecified
TX0734900002Medicare ID - Type Unspecified
TX109521801Medicaid
TX109521802Medicaid
TX00T47RMedicare ID - Type Unspecified
TX0734900003Medicare ID - Type Unspecified