Provider Demographics
NPI:1962451179
Name:SURIEL, SOFIA M (MD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:M
Last Name:SURIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E TIMONIUM RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2836
Mailing Address - Country:US
Mailing Address - Phone:410-248-3124
Mailing Address - Fax:410-246-3125
Practice Address - Street 1:8870 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2401
Practice Address - Country:US
Practice Address - Phone:410-248-3124
Practice Address - Fax:410-248-3125
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO20567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0J0MSMOtherBCBS
MD185191800Medicaid
MD9010-0001OtherCAREFIRST BLUECHOICE
MD9010-0001OtherCAREFIRST BLUECHOICE
MDE13672Medicare UPIN
MD5998SMMedicare PIN