Provider Demographics
NPI:1750471785
Name:SULEK, JOHN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SULEK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1571
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1571
Mailing Address - Country:US
Mailing Address - Phone:301-723-4965
Mailing Address - Fax:301-723-4983
Practice Address - Street 1:500 MEMORIAL AVE STE 307
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3769
Practice Address - Country:US
Practice Address - Phone:301-723-4965
Practice Address - Fax:301-723-4983
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR060315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD618SMedicare ID - Type UnspecifiedMEDICARE INDIV PROVIDER #