Individual
ANDREW SUCOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD07984
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
10/01/2007
BCBS
RI
01
—
12/14/2006
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
1841206976
NPI
RI
05
—
3186865
—
MA
05
—
7006553
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/31/2006
Last updated
02/04/2010
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