Individual
DR. DAMODHAR PATTABIRAMAN SURESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3439
(859) 287-3045
(859) 578-3800
Mailing address
P.O. BOX 636324, CINCINNATI, OH 45263-6324
(859) 344-5555
(859) 344-5552
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35-06-8603-S
OH
207RC0000X
Cardiovascular Disease Physician
37142
KY
207RI0011X
Interventional Cardiology Physician
01085789A
IN
207RI0011X
Interventional Cardiology Physician
Primary
37142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0369016
MEDICARE
KY
01
—
0369209
MEDICARE
KY
01
—
0562616
MEDICARE
KY
01
—
060067789
RAILROAD MEDICARE
—
01
—
0969497
MEDICARE PTAN
KY
05
—
2000420
—
OH
01
—
50024711
PASSPORT MEDICAID
KY
01
—
611300608064
CARESOURCE
OH
05
—
64962830
—
KY
01
—
P00893681
RAILROAD MEDICARE
OH
01
—
P00922859
RAIL ROAD MEDICARE
KY
Enumeration date
07/05/2005
Last updated
12/18/2025
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