Provider Demographics
NPI:1467031864
Name:SURATH, HARSHA VARDHAN (MBBS, MS)
Entity type:Individual
Prefix:
First Name:HARSHA
Middle Name:VARDHAN
Last Name:SURATH
Suffix:
Gender:M
Credentials:MBBS, MS
Other - Prefix:
Other - First Name:HARSHA
Other - Middle Name:VARDHAN
Other - Last Name:SURATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:600 IVY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1627
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2071
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1676
Practice Address - Country:US
Practice Address - Phone:607-737-7770
Practice Address - Fax:607-271-3686
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332400207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine