Healthcare Provider Details

I. General information

NPI: 1255599890
Provider Name (Legal Business Name): SOFIA SURIEL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8870 BELAIR RD
NOTTINGHAM MD
21236-2401
US

IV. Provider business mailing address

308 E TIMONIUM RD
TIMONIUM MD
21093-2836
US

V. Phone/Fax

Practice location:
  • Phone: 410-248-3124
  • Fax: 410-248-3125
Mailing address:
  • Phone: 410-248-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOFIA M SURIEL
Title or Position: PRESIDENT
Credential: M. D.
Phone: 410-248-3124