Provider Demographics
NPI:1093031429
Name:ELANGO, SURATHA (MD)
Entity type:Individual
Prefix:MISS
First Name:SURATHA
Middle Name:
Last Name:ELANGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 BISSONNET ST STE 1000W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8001
Mailing Address - Country:US
Mailing Address - Phone:215-467-5870
Mailing Address - Fax:
Practice Address - Street 1:9700 BISSONNET ST STE 1000W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8001
Practice Address - Country:US
Practice Address - Phone:832-828-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2849208000000X
PAMD451046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics