Individual
ANDREW SUGANTHARAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1612 DOWNTOWN WEST BLVD, KNOXVILLE, TN 37919-5408
(865) 357-8861
(865) 357-8866
Mailing address
1612 DOWNTOWN WEST BLVD, KNOXVILLE, TN 37919-5408
(865) 357-8861
(865) 357-8866
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025789
TN
208M00000X
Hospitalist Physician
25789
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3095110
—
TN
01
—
4064152
BCBS
TN
01
—
5922709
AETNA
TN
01
—
P00078150
PALMETTO GBA-RR MCR
TN
Enumeration date
01/04/2006
Last updated
05/13/2014
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