Provider Demographics
NPI:1417487133
Name:SURESH, SHRUTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTHI
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NEW SCOTLAND AVENUE, DEPT. OF MEDICINE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-3095
Mailing Address - Fax:518-262-6014
Practice Address - Street 1:47 NEW SCOTLAND AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3095
Practice Address - Fax:518-262-6014
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63953390200000X
UT13593971-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program