Provider Demographics
NPI:1720168198
Name:ADDAGATLA, SUJATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:ADDAGATLA
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 1:2900 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1252
Mailing Address - Country:US
Mailing Address - Phone:716-298-1868
Mailing Address - Fax:716-205-0836
Practice Address - Street 1:2900 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1252
Practice Address - Country:US
Practice Address - Phone:716-298-1868
Practice Address - Fax:716-205-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190795207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524501007OtherBLUE CROSS BLUE SHIELD
NY390008664OtherM EDICARE RAILROAD
NY78433OtherGHI HMO
NY00010348704OtherUNIVERA
NY2509942OtherINDEPENDENT HEALTH
NY01630735Medicaid
NY2593770OtherGHI PPO & NETWORK
NY163410BZOtherPREFERRED CARE
NY78433OtherGHI HMO
NY01630735Medicaid