Healthcare Provider Details

I. General information

NPI: 1184824856
Provider Name (Legal Business Name): EUGENE SUWANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 12/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

IV. Provider business mailing address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-4539
  • Fax:
Mailing address:
  • Phone: 301-609-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98752
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD74404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: