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General NPI Number Information
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NPI Number | 1124009667
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Entity Type | Individual
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Provider Name | WILLIAM SUKOVICH MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 600 PETER JEFFERSON PKWY STE 170
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8835
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Country | US
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Telephone | 434-977-3001
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Fax | 434-977-3002
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Provider Business Mailing Address
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Address Line | 600 PETER JEFFERSON PKWY STE 170
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8835
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Country | US
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Telephone | 434-977-3001
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Fax | 434-977-3002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 0101238298
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License Number State | VA
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