Healthcare Provider Details

I. General information

NPI: 1174938146
Provider Name (Legal Business Name): SURUCHI BATRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WISCONSIN AVE NW
WASHINGTON DC
20016-2143
US

IV. Provider business mailing address

150 I ST SE PH 20
WASHINGTON DC
20003-5003
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116027412
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD92648
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD045288
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: