Provider Demographics
NPI:1124105176
Name:CHIRLA, SUGUNA (MD)
Entity type:Individual
Prefix:
First Name:SUGUNA
Middle Name:
Last Name:CHIRLA
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 1:2345 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7319
Mailing Address - Country:US
Mailing Address - Phone:925-418-0282
Mailing Address - Fax:925-978-0991
Practice Address - Street 1:20400 LAKE CHABOT RD STE 102
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5314
Practice Address - Country:US
Practice Address - Phone:510-247-9227
Practice Address - Fax:510-247-9241
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142007207RH0003X
VA0101237970207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK061301Medicare PIN
KYK061300Medicare PIN