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NPI Code Detail

MEDICARE: SUREKHA GORANTLA

MEDICARE:   SUREKHA  GORANTLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1003059DC

General Provider Information

NPI Number : 1144548660
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUREKHA GORANTLA
Provider Business Mailing Address
First Line : 12637 BILLINGTON RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-1506
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 2240 M ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20037-1415
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2010
Last Update Date : 05/04/2016

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Directions to “ SUREKHA GORANTLA ” Practice Location

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