Healthcare Provider Details

I. General information

NPI: 1447505169
Provider Name (Legal Business Name): VAMSIDHAR VENKATA SURYA NARAPARAJU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WOODLAND ST
HARTFORD CT
06105-2372
US

IV. Provider business mailing address

19 WOODLAND ST
HARTFORD CT
06105-2372
US

V. Phone/Fax

Practice location:
  • Phone: 860-525-1234
  • Fax: 860-278-8782
Mailing address:
  • Phone: 860-525-1234
  • Fax: 860-278-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-9278
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number61605
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.060797
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: