Provider Demographics
NPI:1437111598
Name:SRISUMRID, SUTIN - (MD)
Entity Type:Individual
Prefix:DR
First Name:SUTIN
Middle Name:-
Last Name:SRISUMRID
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 1:3703 SUNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3181
Mailing Address - Country:US
Mailing Address - Phone:540-772-0923
Mailing Address - Fax:
Practice Address - Street 1:3703 SUNRIDGE LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3181
Practice Address - Country:US
Practice Address - Phone:540-772-0923
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010262112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology