Provider Demographics
NPI:1104884501
Name:PRASUNA SAJJA MD, PA
Entity type:Organization
Organization Name:PRASUNA SAJJA MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-385-5642
Mailing Address - Street 1:28419 TANNER CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1977
Mailing Address - Country:US
Mailing Address - Phone:713-385-5642
Mailing Address - Fax:
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE 395
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-647-9355
Practice Address - Fax:281-647-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179344001Medicaid
TX00W254Medicare PIN