Provider Demographics
NPI:1629394333
Name:DE RAVIN, SUK S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUK
Middle Name:S
Last Name:DE RAVIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 SOUTHWICK ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3509
Mailing Address - Country:US
Mailing Address - Phone:301-496-6772
Mailing Address - Fax:301-402-8859
Practice Address - Street 1:10 CENTER DR.
Practice Address - Street 2:CRC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20896
Practice Address - Country:US
Practice Address - Phone:301-496-6772
Practice Address - Fax:301-402-8859
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00483991744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study