MEDICARE: DR. PAUL A SURI 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	207RC0000X	Cardiovascular Disease Physician	224491	NY
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	224491	NY
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD443592	PA
4	207RC0000X	Cardiovascular Disease Physician	MD443592	PA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962499400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL A SURI MD

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-707-8484
Fax Number	:	215-707-3699

Provider Business Practice Location Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-8484
Fax Number	:	215-707-3946

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. PAUL A SURI MD” Practice Location

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