Provider Demographics
NPI:1316090954
Name:WADHWA, SURENDER K (MD)
Entity type:Individual
Prefix:
First Name:SURENDER
Middle Name:K
Last Name:WADHWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 TORBETT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-943-3185
Mailing Address - Fax:509-946-8012
Practice Address - Street 1:217 TORBETT STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-943-3185
Practice Address - Fax:509-946-8012
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107168Medicaid
WAAB07567Medicare ID - Type UnspecifiedMEDICARE
WA1107168Medicaid