Provider Demographics
NPI:1598823718
Name:DOUD GALLI, SUZANNE KIM (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KIM
Last Name:DOUD GALLI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-787-0199
Mailing Address - Fax:703-787-0530
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 260
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-787-0199
Practice Address - Fax:703-787-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235229207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery