Basic Information
| Provider Information | |||||||||
| NPI: | 1245285402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURA | ||||||||
| FirstName: | AMISH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | 7048672308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | 7048672308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | D0064227 | MD | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RI0011X | 2018-02147 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | D0064227 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | D0064227 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207U00000X | D0064227 | MD | N | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.