Provider Demographics
NPI:1811059777
Name:C.V. SURENDRANAT MD, PA.
Entity type:Organization
Organization Name:C.V. SURENDRANAT MD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:V
Authorized Official - Last Name:SURENDRANATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-682-0140
Mailing Address - Street 1:PO BOX 680935
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-0935
Mailing Address - Country:US
Mailing Address - Phone:210-682-0140
Mailing Address - Fax:210-682-3238
Practice Address - Street 1:7061 BANDERA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1266
Practice Address - Country:US
Practice Address - Phone:210-682-0140
Practice Address - Fax:210-682-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4257208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA3473OtherPTAN
TX030855301Medicaid
TX0069GMedicare PIN
TX0054HHOtherBCBS