Provider Demographics
NPI:1275568040
Name:NAIR, SUSEELA (MD)
Entity Type:Individual
Prefix:
First Name:SUSEELA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4437
Mailing Address - Country:US
Mailing Address - Phone:410-433-2200
Mailing Address - Fax:410-532-7246
Practice Address - Street 1:5010 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4437
Practice Address - Country:US
Practice Address - Phone:410-433-2200
Practice Address - Fax:410-532-7246
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52290801OtherBLUECROSS/BLUESHIELD MD
MDK615AJ51Medicare ID - Type Unspecified
MD52290801OtherBLUECROSS/BLUESHIELD MD