Provider Demographics
NPI:1508834185
Name:SURELL, JONATHAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ERIC
Last Name:SURELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-2799
Mailing Address - Fax:410-494-2737
Practice Address - Street 1:849 FAIRMONT AVENUE
Practice Address - Street 2:SUITE 100A
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2600
Practice Address - Country:US
Practice Address - Phone:410-494-1369
Practice Address - Fax:410-494-2737
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0032242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70839Medicare UPIN