Provider Demographics
NPI:1811324304
Name:WASON, SUMAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:
Last Name:WASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1960
Mailing Address - Country:US
Mailing Address - Phone:609-480-9149
Mailing Address - Fax:
Practice Address - Street 1:45 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1960
Practice Address - Country:US
Practice Address - Phone:609-480-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07450400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics