Healthcare Provider Details

I. General information

NPI: 1477539294
Provider Name (Legal Business Name): SUNDARARAMA RAJU VATSAVAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FLORIDA BLVD
BATON ROUGE LA
70806
US

IV. Provider business mailing address

PO BOX 732094
DALLAS TX
75373-2094
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7070
  • Fax: 225-387-7700
Mailing address:
  • Phone: 877-744-1141
  • Fax: 225-372-3717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13175R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: