Provider Demographics
NPI:1205869336
Name:SURICHAMORN, PATCHARIN (MD)
Entity type:Individual
Prefix:DR
First Name:PATCHARIN
Middle Name:
Last Name:SURICHAMORN
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 1:3 BROOKFIELD GARTH
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4735
Mailing Address - Country:US
Mailing Address - Phone:410-869-0100
Mailing Address - Fax:410-869-0460
Practice Address - Street 1:4 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-869-0100
Practice Address - Fax:410-869-0460
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2330356OtherAETNA HMO
7360111OtherAETNA PPO
1980499OtherUNITED HEALTHCARE
MD54847Medicaid
76883501OtherCAREFIRST MARYLAND
9628375001OtherCIGNA
9984OtherKAISER
0035OtherCAREFIRST DC
112468OtherCOVENTRY
700248OtherNCPPO
039588OtherJOHNS HOPKINS HEALTHCARE
281958OtherMAMSI
MD757361800Medicaid
MD1980499Medicaid
039588OtherJOHNS HOPKINS HEALTHCARE
F16317Medicare UPIN
700248OtherNCPPO