Provider Demographics
NPI:1417958851
Name:RAMANADHA RAO, SURAPANENI P (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAPANENI
Middle Name:P
Last Name:RAMANADHA RAO
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 1:58 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4112
Mailing Address - Country:US
Mailing Address - Phone:207-469-6880
Mailing Address - Fax:
Practice Address - Street 1:58 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4112
Practice Address - Country:US
Practice Address - Phone:207-469-6880
Practice Address - Fax:207-469-3766
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD9356208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1417958851Medicaid
ME112410000Medicaid
MED03646Medicare UPIN
MERA015107Medicare ID - Type Unspecified