Provider Demographics
NPI:1710925029
Name:BATH, SURINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:S
Last Name:BATH
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 1:911 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1039
Mailing Address - Country:US
Mailing Address - Phone:585-798-2699
Mailing Address - Fax:585-798-3196
Practice Address - Street 1:911 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1039
Practice Address - Country:US
Practice Address - Phone:585-798-2699
Practice Address - Fax:585-798-3196
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00453750Medicaid
NYB35999Medicare UPIN
NY064271Medicare ID - Type Unspecified