Provider Demographics
NPI:1073595294
Name:SUAREZ, ELLIOT DAMIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DAMIAN
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-3904
Practice Address - Country:US
Practice Address - Phone:336-716-9253
Practice Address - Fax:336-713-4501
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205195208000000X
NC2022-00814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190331Medicaid
MAJ23613OtherBCBS
MA205195OtherTUFTS
H51008Medicare UPIN
MA0190331Medicaid