MEDICARE: C.V. SURENDRANAT MD, PA.

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	208600000X	Surgery Physician	K4257	TX
2	2086X0206X	Surgical Oncology Physician	K4257	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OA3473	OTHER	TX	PTAN

General Provider Information

NPI Number	:	1811059777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C.V. SURENDRANAT MD, PA.

Provider Business Mailing Address
First Line	:	PO BOX 680935
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78268-0935
Country	:	US
Telephone Number	:	210-682-0140
Fax Number	:	210-682-3238

Provider Business Practice Location Address
First Line	:	7061 BANDERA RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-682-0140
Fax Number	:	210-682-3238

Authorized Official
Title or Position	:	OWNER
Name	:	DR. C V SURENDRANATH
Credential	:	M.D.
Telephone Number	:	210-682-0140

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	02/19/2016

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