Healthcare Provider Details

I. General information

NPI: 1568784718
Provider Name (Legal Business Name): IRA SUROLIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 JEFFERSON ST
HARTFORD CT
06106-2601
US

IV. Provider business mailing address

85 JEFFERSON ST
HARTFORD CT
06106-2601
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4183
  • Fax: 860-728-0151
Mailing address:
  • Phone: 860-972-4183
  • Fax: 860-728-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number290930
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number290930
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322364
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number322364
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number82682
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: