Healthcare Provider Details

I. General information

NPI: 1629394333
Provider Name (Legal Business Name): SUK S DE RAVIN M.D., PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR. CRC
BETHESDA MD
20896
US

IV. Provider business mailing address

5619 SOUTHWICK ST
BETHESDA MD
20817-3509
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-6772
  • Fax: 301-402-8859
Mailing address:
  • Phone: 301-496-6772
  • Fax: 301-402-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberD0048399
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: