Provider Demographics
NPI:1154672426
Name:SURENDRA, CHRISTOPHER MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SURENDRA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 SE CARY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7413
Mailing Address - Country:US
Mailing Address - Phone:919-467-4992
Mailing Address - Fax:919-232-5328
Practice Address - Street 1:1110 SE CARY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7420
Practice Address - Country:US
Practice Address - Phone:919-467-4992
Practice Address - Fax:919-232-5328
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA9763363A00000X
MDC04849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMD061OtherFL MEDICARE