Provider Demographics
NPI:1972897874
Name:PERAKATHU, SUJA (MD)
Entity Type:Individual
Prefix:
First Name:SUJA
Middle Name:
Last Name:PERAKATHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 W SESAME DR STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8366
Mailing Address - Country:US
Mailing Address - Phone:956-423-3343
Mailing Address - Fax:956-622-3409
Practice Address - Street 1:597 W SESAME DR
Practice Address - Street 2:SUITE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8364
Practice Address - Country:US
Practice Address - Phone:956-622-3157
Practice Address - Fax:956-622-3409
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine