Provider Demographics
NPI:1336170729
Name:KONERU, SUCHITRA (MD)
Entity Type:Individual
Prefix:
First Name:SUCHITRA
Middle Name:
Last Name:KONERU
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 1:6333 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5760
Mailing Address - Country:US
Mailing Address - Phone:716-634-8262
Mailing Address - Fax:716-633-2593
Practice Address - Street 1:400 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5760
Practice Address - Country:US
Practice Address - Phone:716-634-8262
Practice Address - Fax:716-633-2593
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026938601OtherUNIVERA
NY0112743OtherINDEPENDENT HEALTH
NY051019000019OtherFIDELIS
NY050128000096OtherFIDELIS
NY000527972003OtherBLUE CROSS OF WNY
NY00026938603OtherUNIVERA
NY000527972001OtherBLUE CROSS OF WNY
NY0112743OtherINDEPENDENT HEALTH