Provider Demographics
NPI:1124028899
Name:SURACI, ALDO (MD)
Entity Type:Individual
Prefix:
First Name:ALDO
Middle Name:
Last Name:SURACI
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 1:1009 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2305
Mailing Address - Country:US
Mailing Address - Phone:570-759-6491
Mailing Address - Fax:570-759-2440
Practice Address - Street 1:1009 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2305
Practice Address - Country:US
Practice Address - Phone:570-759-6491
Practice Address - Fax:570-759-2440
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027971E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010856750002Medicaid
PA36772Medicare ID - Type Unspecified
PAB34025Medicare UPIN