Provider Demographics
NPI:1790721645
Name:GOLI, SUJATHA A (MD)
Entity type:Individual
Prefix:
First Name:SUJATHA
Middle Name:A
Last Name:GOLI
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 1:21212 NORTHWEST FWY STE 265
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5883
Mailing Address - Country:US
Mailing Address - Phone:281-653-9123
Mailing Address - Fax:281-653-9175
Practice Address - Street 1:21212 NORTHWEST FWY STE 265
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5883
Practice Address - Country:US
Practice Address - Phone:281-653-9123
Practice Address - Fax:281-653-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1822207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3333817Medicaid
TXQ1822OtherTEXAS MEDICAL LICENSE
TXQ1822OtherTEXAS MEDICAL LICENSE