Healthcare Provider Details

I. General information

NPI: 1811059777
Provider Name (Legal Business Name): C.V. SURENDRANAT MD, PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7061 BANDERA RD SUITE 101
SAN ANTONIO TX
78238-1266
US

IV. Provider business mailing address

PO BOX 680935
SAN ANTONIO TX
78268-0935
US

V. Phone/Fax

Practice location:
  • Phone: 210-682-0140
  • Fax: 210-682-3238
Mailing address:
  • Phone: 210-682-0140
  • Fax: 210-682-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberK4257
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberK4257
License Number StateTX

VIII. Authorized Official

Name: DR. C V SURENDRANATH
Title or Position: OWNER
Credential: M.D.
Phone: 210-682-0140