Provider Demographics
NPI:1265470736
Name:SUWAN, SARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARUN
Middle Name:
Last Name:SUWAN
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 1:1629 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-224-4600
Mailing Address - Fax:724-224-2775
Practice Address - Street 1:1629 UNION AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-224-4600
Practice Address - Fax:724-224-2775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072491L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB95829Medicare UPIN