Provider Demographics
NPI:1487725198
Name:PATIL, SURESH FAKIRA (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:FAKIRA
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BUNNER ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3357
Mailing Address - Country:US
Mailing Address - Phone:315-343-8162
Mailing Address - Fax:315-342-2885
Practice Address - Street 1:74 BUNNER ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3357
Practice Address - Country:US
Practice Address - Phone:315-343-8162
Practice Address - Fax:315-342-2885
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1267982084P0805X, 2084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAP6983806OtherDEA NUMBER
C59153Medicare UPIN
NYAP6983806OtherDEA NUMBER