Basic Information
| Provider Information | |||||||||
| NPI: | 1821019803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURA | ||||||||
| FirstName: | ASHWIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5425 BRITTANY DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257670460 | ||||||||
| FaxNumber: | 2257673262 | ||||||||
| Practice Location | |||||||||
| Address1: | 5425 BRITTANY DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257670460 | ||||||||
| FaxNumber: | 2257673262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 07322R | LA | N | Other Service Providers | Specialist | 2084P0800X | 07322R | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 37338 | 01 | LA | BLUE CROSS BLUE SHIELD | OTHER | 1371726 | 05 | LA | MEDICAID |