Individual
RAGHOTHAM REDDY PATLOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4811 AMBASSADOR CAFFERY PARKWAY, SUITE 401A, LAFAYETTE, LA 70508
(337) 456-6523
(337) 456-6521
Mailing address
PO BOX 70, MILTON, LA 70558
(337) 456-6523
(337) 456-6521
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
15607R
LA
207RC0000X
Cardiovascular Disease Physician
23173
MS
207RI0011X
Interventional Cardiology Physician
Primary
15607R
LA
207RI0011X
Interventional Cardiology Physician
23173
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1349844
—
LA
01
—
P00158213
RR MEDICARE
LA
Enumeration date
07/06/2005
Last updated
05/11/2017
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