Healthcare Provider Details

I. General information

NPI: 1376973420
Provider Name (Legal Business Name): SUFFOLK SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0251
  • Fax:
Mailing address:
  • Phone: 757-539-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL HOGG
Title or Position: OWNER
Credential: MD
Phone: 757-539-0251