Provider Demographics
NPI:1215250535
Name:SUMA & DURGA PA
Entity type:Organization
Organization Name:SUMA & DURGA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DURGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-968-3634
Mailing Address - Street 1:4693 MANDOLIN LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3599
Mailing Address - Country:US
Mailing Address - Phone:863-353-1394
Mailing Address - Fax:863-638-5722
Practice Address - Street 1:2243 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8990
Practice Address - Country:US
Practice Address - Phone:863-353-1394
Practice Address - Fax:863-638-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277037700Medicaid
FL68856OtherBCBS OF FL
N379567OtherWELLCARE
1411835OtherAETNA
5764074OtherCIGNA
FL68856OtherBCBS OF FL
5764074OtherCIGNA