Individual
KHETISUDA SUVARNASUDDHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12931 OAK HILL AVE, HAGERSTOWN, MD 21742
(301) 797-9600
(301) 797-3854
Mailing address
593 EDDY STREET, APC 942, PROVIDENCE, RI 02903-7752
(401) 444-5445
(401) 444-9822
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
D0085666
MD
207RN0300X
Nephrology Physician
LP03684
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
520968642
—
MD
Enumeration date
04/30/2013
Last updated
08/10/2018
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