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General NPI Number Information
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NPI Number | 1336313170
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Entity Type | Individual
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Provider Name | ANTON SURATH NISETUS DIAS PERERA MD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1385 W BRIERBROOK RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-2208
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Country | US
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Telephone | 901-390-2930
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Fax | 901-390-2940
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Provider Business Mailing Address
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Address Line | 1375 W BRIERBROOK RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-2208
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Country | US
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Telephone | 901-390-2930
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Fax | 901-390-2940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 45820
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | E12898
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 21384
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 45820
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License Number State | TN
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