Provider Demographics
NPI:1629157383
Name:GHARSE, SURESH PURUSHOTTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:PURUSHOTTAM
Last Name:GHARSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 MONUMENT AVE
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3955
Mailing Address - Country:US
Mailing Address - Phone:804-355-9975
Mailing Address - Fax:804-355-9953
Practice Address - Street 1:3900 MONUMENT AVE
Practice Address - Street 2:SUITE 'A'
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3955
Practice Address - Country:US
Practice Address - Phone:804-355-9975
Practice Address - Fax:804-355-9953
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010283262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA235022OtherANTHEM PPO #
VA235022OtherANTHEM PPO #