Provider Demographics
NPI:1609998434
Name:SUROS, JOSE AT (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:AT
Last Name:SUROS
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 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-7303
Mailing Address - Fax:301-530-7312
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-7303
Practice Address - Fax:301-530-7312
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist