Provider Demographics
NPI:1609090315
Name:SUROWIEC, RICHARD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:SUROWIEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S. EDWIN C. MOSES BLVD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417
Mailing Address - Country:US
Mailing Address - Phone:937-461-1376
Mailing Address - Fax:937-461-9280
Practice Address - Street 1:921 S. EDWIN C. MOSES BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-461-1376
Practice Address - Fax:937-461-9280
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095500207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics