Provider Demographics
NPI:1366603722
Name:NALLAGATLA, SASIKANTH (MD)
Entity type:Individual
Prefix:
First Name:SASIKANTH
Middle Name:
Last Name:NALLAGATLA
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 1:10004 WURZBACH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2214
Mailing Address - Country:US
Mailing Address - Phone:210-417-4142
Mailing Address - Fax:
Practice Address - Street 1:3303 ROGERS RD STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3688
Practice Address - Country:US
Practice Address - Phone:210-417-4142
Practice Address - Fax:210-702-3372
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5273207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287724304Medicaid
TX382690ZLE2Medicare UPIN