Provider Demographics
NPI:1356515829
Name:SUSARLA, SARAT CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:SARAT
Middle Name:CHANDRA
Last Name:SUSARLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-464-4107
Mailing Address - Fax:713-465-4522
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-464-4107
Practice Address - Fax:713-465-4522
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM55302080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00669476Medicare PIN
TX8L0394Medicare PIN