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NPI Code Detail

MEDICARE: SUHASINI MALLADI MD

MEDICARE: SUHASINI MALLADI MD
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
1208000000XPediatrics PhysicianG1948TX

General Provider Information

NPI Number : 1629065511
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUHASINI MALLADI MD
Provider Business Mailing Address
First Line : 319 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 319 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number : 936-634-3713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 07/08/2007

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Directions to “ SUHASINI MALLADI MD” Practice Location

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