MEDICARE: SUPRIYA GERARDINE M.D.

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
1	207RN0300X	Nephrology Physician	A176112	CA

General Provider Information

NPI Number	:	1205217494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUPRIYA GERARDINE M.D.

Provider Business Mailing Address
First Line	:	568 E HERNDON AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-228-6600
Fax Number	:	559-226-3709

Provider Business Practice Location Address
First Line	:	568 E HERNDON AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2989
Country	:	US
Telephone Number	:	559-228-6600
Fax Number	:	559-226-3709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/08/2026

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