Healthcare Provider Details

I. General information

NPI: 1518905504
Provider Name (Legal Business Name): SUHASINI MOPARTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COMBS RD SUITE 4
PENNINGTON GAP VA
24277-1808
US

IV. Provider business mailing address

1800 COMBS RD SUITE 4
PENNINGTON GAP VA
24277-1808
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-3870
  • Fax: 276-546-3872
Mailing address:
  • Phone: 276-546-3870
  • Fax: 276-546-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101239198
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: