Provider Demographics
NPI:1316056088
Name:DWIVEDI, SURESH C (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:C
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:VA MEDICAL CENTER 70 MIDDLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2000
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-266-6014
Practice Address - Street 1:VA MEDICAL CENTER 70 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2000
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6014
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY115692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry