Individual
DR. ANIL KUMAR SURASANI REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502-4830
(315) 798-9788
Mailing address
2209 GENESEE ST, UTICA, NY 13501-5999
(315) 801-4238
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2005851
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040877301
UNIVERA
—
01
—
00931237
MEDICAID GROUP #
—
05
—
02067678
—
NY
01
—
050073887
PALMETTO
—
01
—
100182665001
UHC MC
NY
01
—
10058425
CDPHP
NY
01
—
11316552
CAQH
—
01
—
1826650
UHC
NY
01
—
207045400
US DEPT LABOR
NY
01
—
361307
MVP
—
01
—
40426014144
FIDELIS
—
01
—
54602A
MEDICARE GROUP #
—
Enumeration date
10/26/2005
Last updated
03/03/2022
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