Basic Information
Provider Information | |||||||||
NPI: | 1093026940 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SURU | ||||||||
FirstName: | MIHAELA | ||||||||
MiddleName: | ROXANA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 160 | ||||||||
Address2: | PATIENT FINANCIAL SERVICES | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 03561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032597627 | ||||||||
FaxNumber: | 6032597561 | ||||||||
Practice Location | |||||||||
Address1: | 600 ST. JOHNSBURY RD. | ||||||||
Address2: |   | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 03561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034449000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2010 | ||||||||
LastUpdateDate: | 10/29/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125.055933 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 15662 | NH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 265155 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.