Provider Demographics
NPI:1962077537
Name:KASULA, MEGHANA REDDY (MBBS)
Entity type:Individual
Prefix:
First Name:MEGHANA
Middle Name:REDDY
Last Name:KASULA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRG MIDCITY MEDICINE CLINIC
Mailing Address - Street 2:3401 NORTH BOULEVARD SUITE 130
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-387-7900
Mailing Address - Fax:
Practice Address - Street 1:BRG MID CITY MEDICINE CLINIC
Practice Address - Street 2:3401 NORTH BOULEVARD, SUITE 130
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-387-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-11-29
Deactivation Date:2022-11-23
Deactivation Code:
Reactivation Date:2022-11-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program