Provider Demographics
NPI:1881610418
Name:SURESH, ANAND (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:SURESH
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 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1622252085R0202X
WAMD000441242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0220212OtherL&I-TRA PIERCE COUNTY
WA1093046Medicaid
WA0220211OtherL&I-UNION AVENUE OPEN MRI
OR500666534Medicaid
WA0249531OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA8870250OtherPTAN-UAOM
WA8951837OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA0220212OtherLABOR AND INDUSTRIES-TRA
WA8944290OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA8870249OtherPTAN-TRA KING CO
WA8944287OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA