Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | D0064227 | MD |
Y | 207RI0011X | Interventional Cardiology | 2018-02147 | NC |
N | 207RI0011X | Interventional Cardiology | D0064227 | MD |
N | 207U00000X | Nuclear Medicine Specialist | D0064227 | MD |
NPI | 1245285402 |
---|---|
Provider Name | Amish C Sura |
First Address | Gastonia, NC 28054-2178 |
Second Address | Gastonia, NC 28054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 27/08/2018 |