Provider Demographics
NPI:1407846959
Name:REDDY, ANIL KUMAR SURASANI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL KUMAR
Middle Name:SURASANI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5999
Mailing Address - Country:US
Mailing Address - Phone:315-801-4238
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-798-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2005851207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00931237OtherMEDICAID GROUP #
050073887OtherPALMETTO
NY207045400OtherUS DEPT LABOR
0040877301OtherUNIVERA
361307OtherMVP
NY02067678Medicaid
54602AOtherMEDICARE GROUP #
NY100182665001OtherUHC MC
NY10058425OtherCDPHP
NY1826650OtherUHC
40426014144OtherFIDELIS
11316552OtherCAQH
NY100182665001OtherUHC MC
361307OtherMVP