Healthcare Provider Details

I. General information

NPI: 1427051788
Provider Name (Legal Business Name): SURESH M SHRESTHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 SETON DR
CUMBERLAND MD
21502-1950
US

IV. Provider business mailing address

PO BOX 808
CUMBERLAND MD
21501-0808
US

V. Phone/Fax

Practice location:
  • Phone: 301-724-1646
  • Fax: 301-724-7429
Mailing address:
  • Phone: 301-724-1646
  • Fax: 301-724-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0020258
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: