Healthcare Provider Details

I. General information

NPI: 1205018991
Provider Name (Legal Business Name): SUREKHA PARIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 COLONY RD
MADISON HEIGHTS VA
24572-2105
US

IV. Provider business mailing address

PO BOX 1098
LYNCHBURG VA
24505-1098
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-6320
  • Fax: 434-947-2906
Mailing address:
  • Phone: 434-947-6320
  • Fax: 434-947-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101030604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: