MEDICARE: DR. SUMAN PINNAMANENI VEERAGANDHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01050753A	IN
2	207V00000X	Obstetrics & Gynecology Physician	G88030	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000215421	OTHER		BLUE CROSS BLUE SHIELD
2	0091107872	OTHER	IL	BCBS ILLINOIS

General Provider Information

NPI Number	:	1194721738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMAN PINNAMANENI VEERAGANDHAM M.D.

Provider Business Mailing Address
First Line	:	20126 STANTON AVE STE 201
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5270
Country	:	US
Telephone Number	:	510-581-2559
Fax Number	:	510-581-5396

Provider Business Practice Location Address
First Line	:	20126 STANTON AVE STE 201
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5270
Country	:	US
Telephone Number	:	510-581-2559
Fax Number	:	510-581-5396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/08/2019

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