Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 04740R | LA |
N | 2080A0000X | Adolescent Medicine | 04740R | LA |
NPI | 1093779654 |
---|---|
Provider Name | Dr. Vasanth K Nalam |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Lafayette, LA 70508-6908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1198412 | (05) | LA |
B89219 | (02) |