Healthcare Provider Details

I. General information

NPI: 1144268707
Provider Name (Legal Business Name): SURESH NAGAPPAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 400
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

301 E WENDOVER AVE STE 400
GREENSBORO NC
27401-1230
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3150
  • Fax:
Mailing address:
  • Phone: 336-832-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200400925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: