MEDICARE: NARSINGAM GATLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	R6379	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	194361	OTHER	MO	BLUE CROSS BLUE SHIELD
4	3848	OTHER	MO	CMR
5	27716	OTHER	MO	GROUP HEALTH PLAN

General Provider Information

NPI Number	:	1255364279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARSINGAM GATLA M.D.

Provider Business Mailing Address
First Line	:	2344 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2909
Country	:	US
Telephone Number	:	314-647-2344
Fax Number	:	314-647-5108

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 280
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-727-0012
Fax Number	:	314-727-0014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/19/2008

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Directions to “ NARSINGAM GATLA M.D.” Practice Location

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