Provider Demographics
NPI:1962493569
Name:KANAGALA, ANITA (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:KANAGALA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:NAGABHYRU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7512
Mailing Address - Country:US
Mailing Address - Phone:985-892-6858
Mailing Address - Fax:
Practice Address - Street 1:130 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7512
Practice Address - Country:US
Practice Address - Phone:985-892-6858
Practice Address - Fax:985-892-6965
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47113207Q00000X
LAMD.202626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1805742Medicaid
LA1805742Medicaid
H41144Medicare UPIN