MEDICARE: DR. NANCY J. SURIG 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	207W00000X	Ophthalmology Physician	D0036989	MD

General Provider Information

NPI Number	:	1871737676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY J. SURIG MD

Provider Business Mailing Address
First Line	:	15005 SHADY GROVE RD.
Second Line	:	SUITE 100
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6341
Country	:	US
Telephone Number	:	301-279-9696
Fax Number	:	301-251-5454

Provider Business Practice Location Address
First Line	:	15005 SHADY GROVE RD.
Second Line	:	STE 100
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6341
Country	:	US
Telephone Number	:	301-279-9696
Fax Number	:	301-251-5454

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	07/11/2011

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