MEDICARE: SUMANA SURESH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0101237866	VA

General Provider Information

NPI Number	:	1053361667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMANA SURESH M.D.

Provider Business Mailing Address
First Line	:	500 N WASHINGTON ST STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	703-522-1175
Fax Number	:	703-522-2608

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON ST STE 200
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	703-522-1175
Fax Number	:	703-522-2608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/30/2020

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