Individual
DR. SURESH JAGANNATH PENKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
145 KIMEL PARK DR, SUITE 300, WINSTON SALEM, NC 27103-6984
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR, SUITE 300, WINSTON SALEM, NC 27103-6984
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20678
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1373R
BCBS
NC
05
—
8966745
—
NC
01
—
P00184454
RR MEDICARE
NC
Enumeration date
07/21/2006
Last updated
07/08/2007
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