Provider Demographics
NPI:1932405297
Name:SURAPANENI, SRAVYA SUDHA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SRAVYA
Middle Name:SUDHA
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E APPLE ST
Mailing Address - Street 2:WRIGHT STATE UNIV DEPT OF INTERNAL MEDICINE, 2ND FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2902
Mailing Address - Country:US
Mailing Address - Phone:937-208-2866
Mailing Address - Fax:
Practice Address - Street 1:128 E APPLE ST
Practice Address - Street 2:WRIGHT STATE UNIV DEPT OF INTERNAL MEDICINE, 2ND FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2902
Practice Address - Country:US
Practice Address - Phone:937-208-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35123666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103667Medicaid
OHH315980Medicare PIN
OH0103667Medicaid