Provider Demographics
NPI:1760424220
Name:SURI, DEEPIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPIKA
Middle Name:
Last Name:SURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MCFARLAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2479
Mailing Address - Country:US
Mailing Address - Phone:610-925-3835
Mailing Address - Fax:610-925-3834
Practice Address - Street 1:404 MCFARLAN RD STE 101
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2479
Practice Address - Country:US
Practice Address - Phone:610-925-3835
Practice Address - Fax:610-925-3834
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471295207R00000X, 207R00000X
MI4301075322207RN0300X
KY38385207RN0300X
OH35-083284207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4148142Medicaid
OH0616004037Medicare ID - Type Unspecified
OH4148142Medicaid