Provider Demographics
NPI:1598095598
Name:SUEDE SURGICAL CARE LLC
Entity Type:Organization
Organization Name:SUEDE SURGICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:MAHER
Authorized Official - Last Name:SUEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-432-2100
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3536
Mailing Address - Country:US
Mailing Address - Phone:860-432-2100
Mailing Address - Fax:860-432-5330
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3536
Practice Address - Country:US
Practice Address - Phone:860-432-2100
Practice Address - Fax:860-432-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty