Provider Demographics
NPI:1386622033
Name:SUGANTHARAJ, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SUGANTHARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 DOWNTOWN WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5408
Mailing Address - Country:US
Mailing Address - Phone:865-357-8861
Mailing Address - Fax:865-357-8866
Practice Address - Street 1:1612 DOWNTOWN WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5408
Practice Address - Country:US
Practice Address - Phone:865-357-8861
Practice Address - Fax:865-357-8866
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25789208M00000X
TN025789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4064152OtherBCBS
TN5922709OtherAETNA
TN3095110Medicaid
TNP00078150OtherPALMETTO GBA-RR MCR
TNP00078150OtherPALMETTO GBA-RR MCR
G25738Medicare UPIN