=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962488056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROHIT SURI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 06/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3903 FAIR RIDGE DR SUITE 219
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 709-865-6490
-----------------------------------------------------
Fax | 703-865-6492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3903 FAIR RIDGE DR STE 209
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033-2944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 709-865-6490
-----------------------------------------------------
Fax | 703-865-6492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME85329
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QB0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 0101246943
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------