Provider Demographics
NPI:1275587396
Name:MADHIRAJU, SUHAS (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:
Last Name:MADHIRAJU
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 1:201 BALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3632
Mailing Address - Country:US
Mailing Address - Phone:410-686-3931
Mailing Address - Fax:
Practice Address - Street 1:201 BALLARD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3632
Practice Address - Country:US
Practice Address - Phone:410-686-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKCE8 61607001OtherCAREFIRST BC-BS
MDS189 / 0036OtherBLUECHOICE
MDKF68 / 616070-02OtherBC / BS OF MD
MDR103-002OtherBLUE CHOICE
MD798501100Medicaid
H67065Medicare UPIN