Healthcare Provider Details

I. General information

NPI: 1578926101
Provider Name (Legal Business Name): VICTORIA JENETS SURMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA JENETS M.D.

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2393
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD210001925
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD86883
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD86883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: