Healthcare Provider Details

I. General information

NPI: 1275536971
Provider Name (Legal Business Name): ERIC PINN SUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 FALLS RD STE 300
BALTIMORE MD
21209-2219
US

IV. Provider business mailing address

6115 FALLS RD STE 300
BALTIMORE MD
21209-2219
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-7611
  • Fax: 410-377-8221
Mailing address:
  • Phone: 410-377-7611
  • Fax: 410-377-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0051444
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-039313-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: