Healthcare Provider Details

I. General information

NPI: 1134968399
Provider Name (Legal Business Name): SAMPADA ASHOK KUWAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 08/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BOULEVARD, SUITE 130 BRG MID CITY MEDICINE C
BATON ROUGE LA
70806
US

IV. Provider business mailing address

3401 NORTH BOULEVARD, SUITE 130 BRG MID CITY MEDICINE C
BATON ROUGE LA
70806
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7900
  • Fax:
Mailing address:
  • Phone: 225-387-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: