Provider Demographics
NPI:1194721738
Name:VEERAGANDHAM, SUMAN PINNAMANENI (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:PINNAMANENI
Last Name:VEERAGANDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMAN
Other - Middle Name:
Other - Last Name:PINNAMANENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20126 STANTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5270
Mailing Address - Country:US
Mailing Address - Phone:510-581-2559
Mailing Address - Fax:510-581-5396
Practice Address - Street 1:20126 STANTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5270
Practice Address - Country:US
Practice Address - Phone:510-581-2559
Practice Address - Fax:510-581-5396
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050753A207V00000X
CAG88030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000215421OtherBLUE CROSS BLUE SHIELD
IL0091107872OtherBCBS ILLINOIS