MEDICARE: DR. SURA U EDMOND MD

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	207V00000X	Obstetrics & Gynecology Physician	D0082246	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C06778	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1154522688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURA U EDMOND MD

Provider Business Mailing Address
First Line	:	PO BOX 1100
Second Line	:	STE 102
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-1100
Country	:	US
Telephone Number	:	240-245-0821
Fax Number	:	240-252-2141

Provider Business Practice Location Address
First Line	:	4379 RIDGEWOOD CENTER DR
Second Line	:	STE 102
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-8322
Country	:	US
Telephone Number	:	703-680-7950
Fax Number	:	703-680-7953

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	09/14/2016

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Directions to “ DR. SURA U EDMOND MD” Practice Location

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