Provider Demographics
NPI:1790981868
Name:TAMMINENI, SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:
Last Name:TAMMINENI
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 1:100 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9762
Mailing Address - Country:US
Mailing Address - Phone:412-330-3030
Mailing Address - Fax:412-330-3060
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:412-330-3030
Practice Address - Fax:412-330-3060
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018509208M00000X
VA0101262472208M00000X
PAMD469555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790981868Medicaid