Healthcare Provider Details

I. General information

NPI: 1184065161
Provider Name (Legal Business Name): SUVASH SHRESTHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OLD ROLLINSFORD ROAD BUILDING B
DOVER NH
03820
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-4513
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-4265
  • Fax:
Mailing address:
  • Phone: 617-726-3884
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15250
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24081
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: