Provider Demographics
NPI:1639195969
Name:SUSSEX SURGICAL PA
Entity Type:Organization
Organization Name:SUSSEX SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-629-3600
Mailing Address - Street 1:1340 MIDDLEFORD RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3665
Mailing Address - Country:US
Mailing Address - Phone:302-629-3600
Mailing Address - Fax:302-629-3744
Practice Address - Street 1:1340 MIDDLEFORD RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3665
Practice Address - Country:US
Practice Address - Phone:302-629-3600
Practice Address - Fax:302-629-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004841208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000739701Medicaid
DEG01918Medicare ID - Type Unspecified
DEF45941Medicare UPIN