Provider Demographics
NPI:1265446694
Name:SURANA, GYAN C (MD)
Entity type:Individual
Prefix:DR
First Name:GYAN
Middle Name:C
Last Name:SURANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5554 MUDDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20733-2410
Mailing Address - Country:US
Mailing Address - Phone:410-867-6700
Mailing Address - Fax:410-867-6860
Practice Address - Street 1:5554 MUDDY CREEK RD
Practice Address - Street 2:
Practice Address - City:CHURCHTON
Practice Address - State:MD
Practice Address - Zip Code:20733-2410
Practice Address - Country:US
Practice Address - Phone:410-867-6700
Practice Address - Fax:410-867-6860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0050653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD154360101Medicaid
MD003RMedicare ID - Type Unspecified