Provider Demographics
NPI:1518905504
Name:MOPARTY, SUHASINI (MD)
Entity Type:Individual
Prefix:
First Name:SUHASINI
Middle Name:
Last Name:MOPARTY
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 1:1800 COMBS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-1808
Mailing Address - Country:US
Mailing Address - Phone:276-546-3870
Mailing Address - Fax:276-546-3872
Practice Address - Street 1:1800 COMBS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-1808
Practice Address - Country:US
Practice Address - Phone:276-546-3870
Practice Address - Fax:276-546-3872
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239198208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00439745Medicare PIN
VA014661W82Medicare PIN