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General NPI Number Information
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NPI Number | 1407846959
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Entity Type | Individual
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Provider Name | ANIL KUMAR SURASANI REDDY MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 1656 CHAMPLIN AVE
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-798-9788
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13501-5999
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Country | US
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Telephone | 315-801-4238
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Fax | 315-801-8391
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2005851
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License Number State | NY
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