Healthcare Provider Details

I. General information

NPI: 1538554951
Provider Name (Legal Business Name): STEPHEN SUAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 308
WASHINGTON DC
20016-4382
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 308
WASHINGTON DC
20016-4382
US

V. Phone/Fax

Practice location:
  • Phone: 202-695-1000
  • Fax:
Mailing address:
  • Phone: 386-527-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD047619
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: