Provider Demographics
NPI:1578631248
Name:SUMAN K. DAS MD PA
Entity Type:Organization
Organization Name:SUMAN K. DAS MD PA
Other - Org Name:DAS PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-362-0611
Mailing Address - Street 1:2629 COURTHOUSE CRL
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9521
Mailing Address - Country:US
Mailing Address - Phone:601-362-0611
Mailing Address - Fax:601-362-0192
Practice Address - Street 1:2629 COURTHOUSE CRL
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9521
Practice Address - Country:US
Practice Address - Phone:601-362-0611
Practice Address - Fax:601-362-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10570208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015355Medicaid
MSC48204Medicare UPIN