Basic Information
Provider Information
NPI: 1184897134
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SURA
FirstName: SIDDHARTH
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 415 N CENTER ST
Address2: SUITE 300
City: HICKORY
State: NC
PostalCode: 286015057
CountryCode: US
TelephoneNumber: 8283283300
FaxNumber: 8282612080
Practice Location
Address1: 415 N CENTER ST
Address2: SUITE 300
City: HICKORY
State: NC
PostalCode: 286015057
CountryCode: US
TelephoneNumber: 8283283300
FaxNumber: 8282612080
Other Information
ProviderEnumerationDate: 04/10/2008
LastUpdateDate: 07/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X2014-01092NCY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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