Provider Demographics
NPI:1053361667
Name:SURESH, SUMANA (MD)
Entity type:Individual
Prefix:
First Name:SUMANA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3514
Mailing Address - Country:US
Mailing Address - Phone:703-522-1175
Mailing Address - Fax:703-522-2608
Practice Address - Street 1:500 N WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3514
Practice Address - Country:US
Practice Address - Phone:703-522-1175
Practice Address - Fax:703-522-2608
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012378662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry