Provider Demographics
NPI:1114579695
Name:SUH, ANTHONY A
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:SUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 MIDSHIP CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1911
Mailing Address - Country:US
Mailing Address - Phone:240-486-4883
Mailing Address - Fax:
Practice Address - Street 1:5446 MIDSHIP CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1911
Practice Address - Country:US
Practice Address - Phone:240-486-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14502374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide