Provider Demographics
NPI:1861549545
Name:RAMMOHAN, SURIANARAYANAN (MD)
Entity type:Individual
Prefix:
First Name:SURIANARAYANAN
Middle Name:
Last Name:RAMMOHAN
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 1:2949 ELMWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1356
Mailing Address - Country:US
Mailing Address - Phone:716-877-0053
Mailing Address - Fax:716-877-1767
Practice Address - Street 1:50 ALCONA AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2201
Practice Address - Country:US
Practice Address - Phone:716-834-1193
Practice Address - Fax:716-834-1382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0027322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528993001OtherBLUE CROSS WNY
NY1714163OtherINDEPENDENT HEALTH
NY00027895501OtherUNIVERA HEALTHCARE
NY02848497Medicaid
NY02848497Medicaid