Provider Demographics
NPI:1255364279
Name:GATLA, NARSINGAM (MD)
Entity type:Individual
Prefix:
First Name:NARSINGAM
Middle Name:
Last Name:GATLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2909
Mailing Address - Country:US
Mailing Address - Phone:314-647-2344
Mailing Address - Fax:314-647-5108
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-727-0012
Practice Address - Fax:314-727-0014
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR63792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207359902Medicaid
IL036054290Medicaid
MO194361OtherBLUE CROSS BLUE SHIELD
MO3848OtherCMR
MO27716OtherGROUP HEALTH PLAN
IL036054290Medicaid
MO3848OtherCMR