Provider Demographics
NPI:1922021955
Name:SOORYA, NARENDIR T (MD)
Entity Type:Individual
Prefix:
First Name:NARENDIR
Middle Name:T
Last Name:SOORYA
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 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3854
Practice Address - Country:US
Practice Address - Phone:314-843-4333
Practice Address - Fax:314-843-4856
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO339162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
404079360054OtherAETNA
A10898OtherMERCY HMO
278079OtherVALUE OPTIONS
4212065868001OtherANTHEM BLUE CROSS
6902OtherBLUE CROSS
826261058OtherRAILROAD MEDICARE
826261058OtherRAILROAD MEDICARE
000003851Medicare ID - Type Unspecified