Provider Demographics
NPI:1699713198
Name:PATIBANDLA, SUMALATHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMALATHA
Middle Name:
Last Name:PATIBANDLA
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-813-1686
Practice Address - Fax:409-813-3052
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7102207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514019YZ21Medicaid
TX159914401Medicaid
TX159914402Medicaid
TX159914403Medicaid
TX8R1522OtherBLUE CROSS OF TEXAS
TX514019YZ21Medicaid
TX159914401Medicaid
TX8F0566Medicare PIN
TX8A9930Medicare PIN
TX8K8589Medicare PIN