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General NPI Number Information
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NPI Number | 1639453954
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Entity Type | Organization
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Legal Business Name | SURAPANENI RAMANADHARAO MDPA
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 358 BROADWAY SUITE 207
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City | BANGOR
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State | ME
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Zip | 04401-3929
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Country | US
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Telephone | 207-942-3878
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Fax | 207-990-2803
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Provider Business Mailing Address
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Address Line | PO BOX 8117
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City | BANGOR
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State | ME
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Zip | 04402-8117
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Country | US
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Telephone | 207-942-3878
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Fax | 207-990-2803
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. SURAPANENI P RAMANADHARAO
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Credential | M.D.
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Telephone | 207-942-3878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 9356
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License Number State | ME
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