Provider Demographics
NPI:1962464297
Name:DONEPUDI, SARAT K (MD)
Entity Type:Individual
Prefix:
First Name:SARAT
Middle Name:K
Last Name:DONEPUDI
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:PO BOX 160
Mailing Address - Street 2:21420 HWY 20W
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-0160
Mailing Address - Country:US
Mailing Address - Phone:225-265-3013
Mailing Address - Fax:225-265-3775
Practice Address - Street 1:21420 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-3614
Practice Address - Country:US
Practice Address - Phone:225-265-3013
Practice Address - Fax:225-265-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04724R208600000X
LA4727R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1197530Medicaid
5K296OtherOLD MEDICARE
D79356Medicare UPIN
5K296OtherOLD MEDICARE
LA1197530Medicaid