Provider Demographics
NPI:1760839948
Name:SURA, AMOL ASHWIN (MD)
Entity type:Individual
Prefix:
First Name:AMOL
Middle Name:ASHWIN
Last Name:SURA
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 1:10 KORET WAY RM K304
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2218
Mailing Address - Country:US
Mailing Address - Phone:415-353-2142
Mailing Address - Fax:
Practice Address - Street 1:95 KIRKHAM ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3814
Practice Address - Country:US
Practice Address - Phone:415-476-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169296207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology