Provider Demographics
NPI:1689674269
Name:ALDO SURACI MD PC
Entity Type:Organization
Organization Name:ALDO SURACI MD PC
Other - Org Name:SURACI & SRINIVASAN UROLOGIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SURACI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-759-6491
Mailing Address - Street 1:1009 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2305
Mailing Address - Country:US
Mailing Address - Phone:570-759-6491
Mailing Address - Fax:570-759-2440
Practice Address - Street 1:1009 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2305
Practice Address - Country:US
Practice Address - Phone:570-759-6491
Practice Address - Fax:570-759-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027971F208800000X
PAMD027971E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007626300005Medicaid
PA29114Medicare PIN