Healthcare Provider Details

I. General information

NPI: 1124009667
Provider Name (Legal Business Name): WILLIAM SUKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY STE 170
CHARLOTTESVILLE VA
22911-8835
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY STE 170
CHARLOTTESVILLE VA
22911-8835
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-3001
  • Fax: 434-977-3002
Mailing address:
  • Phone: 434-977-3001
  • Fax: 434-977-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0101238298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: