Provider Demographics
NPI:1255599890
Name:SOFIA SURIEL MD PA
Entity type:Organization
Organization Name:SOFIA SURIEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SURIEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:410-248-3124
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185191800Medicaid
MD0J0MOtherBCBS
MDW488OtherBCBS
MD9010OtherCAREFIRST BLUECHOICE
MD9010OtherCAREFIRST BLUECHOICE
E13672Medicare UPIN
MD5998SMMedicare PIN
MD129552Medicare PIN