Provider Demographics
NPI:1386490019
Name:SURAVARAM, POOJA REDDY (MD)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:REDDY
Last Name:SURAVARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DEKALB PIKE SUBURBAN COMMUNITY HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:NORRITOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401
Mailing Address - Country:US
Mailing Address - Phone:610-292-6519
Mailing Address - Fax:610-278-2832
Practice Address - Street 1:2701 DEKALB PIKE SUBURBAN COMMUNITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:NORRITOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-292-6519
Practice Address - Fax:610-278-2832
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT231435390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program