Provider Demographics
NPI:1396705869
Name:NEVATIA, SURENDRA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SURENDRA
Middle Name:KUMAR
Last Name:NEVATIA
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 1:92 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4383
Mailing Address - Country:US
Mailing Address - Phone:518-793-9055
Mailing Address - Fax:
Practice Address - Street 1:92 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4383
Practice Address - Country:US
Practice Address - Phone:518-793-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152775207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00889510Medicaid
NY56148CMedicare PIN
NYA57170Medicare UPIN