Provider Demographics
NPI:1639313570
Name:GYAN C SURANA MD.PC.
Entity Type:Organization
Organization Name:GYAN C SURANA MD.PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-867-6700
Mailing Address - Street 1:5554 MUDDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20733-2410
Mailing Address - Country:US
Mailing Address - Phone:410-867-6700
Mailing Address - Fax:410-867-6860
Practice Address - Street 1:5851 DEALE CHURCHTON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751-2202
Practice Address - Country:US
Practice Address - Phone:410-867-6764
Practice Address - Fax:410-867-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD154360100Medicaid
MD154360101Medicaid
MD154360100Medicaid
MD003RMedicare PIN