Provider Demographics
NPI:1366682031
Name:PRIYA SURESH MD
Entity Type:Organization
Organization Name:PRIYA SURESH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMAPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-428-3359
Mailing Address - Street 1:4111 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1731
Mailing Address - Country:US
Mailing Address - Phone:281-201-4992
Mailing Address - Fax:281-946-8379
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 192
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-201-4992
Practice Address - Fax:281-946-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8209261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI20935Medicare UPIN