1326046871 NPI number — DR. GURURAU SUDARSHAN MD, FRCA, FFARCSI

Table of content: DR. GURURAU SUDARSHAN MD, FRCA, FFARCSI (NPI 1326046871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326046871 NPI number — DR. GURURAU SUDARSHAN MD, FRCA, FFARCSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUDARSHAN
Provider First Name:
GURURAU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FRCA, FFARCSI
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326046871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 631648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-1648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-0022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8261 CORNELL RD
Provider Second Line Business Practice Location Address:
SUITE 630
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45249-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-891-0022
Provider Business Practice Location Address Fax Number:
513-672-0830
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  35070633 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 35070633 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0299690 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: SU0809923 . This is a "MEDICARE ID-" identifier . This identifiers is of the category "OTHER".




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