Provider Demographics
NPI:1861483414
Name:SUHOCKI, DAVID M (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SUHOCKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2626
Mailing Address - Country:US
Mailing Address - Phone:203-879-6171
Mailing Address - Fax:203-879-1191
Practice Address - Street 1:464 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2626
Practice Address - Country:US
Practice Address - Phone:203-879-6171
Practice Address - Fax:203-879-1191
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2V4549OtherHEALTHNET
CT290001103CT02OtherANTHEM BLUE CROSS
CTP00087222OtherRAILROAD MEDICARE
CT00422108200OtherBLUE CARE FAMILY PLAN
CT011030OtherCONNECTICARE
CO275591OtherWELLCARE
CO2V4549OtherHEALTHNET
CT011030OtherCONNECTICARE