Individual
SRINIVAS M SUSARLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
Contact information
Practice address
4800 SAND POINT WAY NE, SEATTLE CHILDREN'S HOSPITAL, SEATTLE, WA 98105-3901
(206) 987-5223
Mailing address
4800 SAND POINT WAY NE, SEATTLE CHILDREN'S HOSPITAL, SEATTLE, WA 98105-3901
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DF60668028
WA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD60628000
WA
Other
Enumeration date
08/05/2007
Last updated
08/28/2017
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