Provider Demographics
NPI:1942279880
Name:VEERAMACHANENI, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:VEERAMACHANENI
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:PO BOX 15090
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92803-5090
Mailing Address - Country:US
Mailing Address - Phone:714-771-8000
Mailing Address - Fax:714-937-7083
Practice Address - Street 1:1100 W STEWART DR STE 3205
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-771-8000
Practice Address - Fax:714-937-7083
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74669208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912919804OtherNPI - TYPE 2
CAA74669OtherSTATE MEDICAL LICENSE (SINCE 5/2001)
AZ1447427018OtherNPI - TYPE 2
AZ43237OtherSTATE MEDICAL LICENSE (SINCE 8/2010)
AZ568683Medicaid
CA110244881Medicare PIN
AZ1447427018OtherNPI - TYPE 2
CACG5665Medicare PIN
CAA74669OtherSTATE MEDICAL LICENSE (SINCE 5/2001)
CAW1514Medicare PIN
CA1912919804OtherNPI - TYPE 2