MEDICARE: SUMAN MADANLAL WASAN 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	207R00000X	Internal Medicine Physician	2019-01868	NC
2	207RC0000X	Cardiovascular Disease Physician	2019-01868	NC
3	2086S0129X	Vascular Surgery Physician	2019-01868	NC

General Provider Information

NPI Number	:	1427027242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMAN MADANLAL WASAN MD

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	367-164-1513
Fax Number	:	336-716-0524

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-7521
Country	:	US
Telephone Number	:	336-716-4151
Fax Number	:	336-716-0524

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	08/08/2025

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Directions to “ SUMAN MADANLAL WASAN MD” Practice Location

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