Basic Information
Provider Information
NPI: 1083022677
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADHIKARI
FirstName: SUMAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 416 COLEGATE DR BLDG 3
Address2:  
City: MARIETTA
State: OH
PostalCode: 457509549
CountryCode: US
TelephoneNumber: 7403743526
FaxNumber: 7403743165
Practice Location
Address1: 310 E 8TH ST STE 130
Address2:  
City: MARIETTA
State: OH
PostalCode: 457503379
CountryCode: US
TelephoneNumber: 7403737197
FaxNumber: 7403737198
Other Information
ProviderEnumerationDate: 07/27/2014
LastUpdateDate: 08/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X35130480OHY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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