Provider Demographics
NPI:1942327093
Name:SURAPANENI, PRATHIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHIMA
Middle Name:
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VEAZEY DR
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 VEAZEY DR
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1668
Practice Address - Country:US
Practice Address - Phone:919-764-2343
Practice Address - Fax:919-933-6881
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine