Basic Information
| Provider Information | |||||||||
| NPI: | 1447327085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAGANATHAN | ||||||||
| FirstName: | SUDHA | ||||||||
| MiddleName: | PRASAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNC HOSPITALS- BURNETT-WOMACK BUILDING | ||||||||
| Address2: | 160 DENTAL CIRCLE CB#7075 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665205 | ||||||||
| FaxNumber: | 9199661743 | ||||||||
| Practice Location | |||||||||
| Address1: | UNC HOSPITALS 6TH FLOOR BURNETT-WOMACK BUILDING | ||||||||
| Address2: | 160 DENTAL CIRCLE CB#7075 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665205 | ||||||||
| FaxNumber: | 9199661743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.090787 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2873412 | 05 | OH | MEDICAID |