Sujana K Patibandla MD Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

35048212 Issued in OH

Legal business name

SUJANA K PATIBANDLA MD INC

Practice address

4186 Holiday St NW
Canton, OH 44718-2532

Phone

(330) 492-5210

Fax

(330) 492-5230

NPI assigned

Sep 30, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sujana K Patibandla, MD

Title

Owner

Phone

(330) 492-5210

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1487988028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4186 HOLIDAY ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182532",
            "telephone_number": "330-492-5210",
            "fax_number": "330-492-5230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4186 HOLIDAY ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182532",
            "telephone_number": "330-492-5210",
            "fax_number": "330-492-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUJANA K PATIBANDLA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "PATIBANDLA",
        "authorized_official_first_name": "SUJANA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-492-5210",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "35048212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0505742",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Canton, OH
• Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.