Provider Demographics
NPI:1124009667
Name:SUKOVICH, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SUKOVICH
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 1:600 PETER JEFFERSON PKWY
Mailing Address - Street 2:STE 170
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8835
Mailing Address - Country:US
Mailing Address - Phone:434-977-3001
Mailing Address - Fax:434-977-3002
Practice Address - Street 1:600 PETER JEFFERSON PKWY
Practice Address - Street 2:STE 170
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8835
Practice Address - Country:US
Practice Address - Phone:434-977-3001
Practice Address - Fax:434-977-3002
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238298207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010240573Medicaid
VA10003995OtherCOMMUNITY HEALTH
VA415564OtherSOUTHERN HEALTH
VAP00285406OtherMEDICARE PIN
VAP00285406OtherRAILROAD MEDICARE
VA188897Medicaid
VA738220OtherMAMSI
VA10003995Medicaid
VA188897OtherANTHEM/HEALTHKEEPERS
VA1219881OtherCIGNA
VA00W985S01Medicare PIN
VAP00285406OtherRAILROAD MEDICARE
VA415564OtherSOUTHERN HEALTH