Provider Demographics
NPI:1558327973
Name:SURYANARAYANAN, SOWMYA K (M D)
Entity type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:K
Last Name:SURYANARAYANAN
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 RALEIGH ROAD PKWY W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9742
Mailing Address - Country:US
Mailing Address - Phone:252-246-8840
Mailing Address - Fax:252-246-8841
Practice Address - Street 1:3724 RALEIGH ROAD PKWY W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9742
Practice Address - Country:US
Practice Address - Phone:252-246-8840
Practice Address - Fax:252-246-8841
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01162207RE0101X
FLME117683207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558327973Medicaid
CO42779022Medicaid
COCO40761Medicare PIN
I41416Medicare UPIN
FL010340900Medicaid
FLHP562YMedicare PIN
FLHP562XMedicare PIN