Provider Demographics
NPI:1104912294
Name:SUATENGCO, DOMINGO E (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:E
Last Name:SUATENGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-476-0901
Mailing Address - Fax:702-264-9762
Practice Address - Street 1:3700 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1744
Practice Address - Country:US
Practice Address - Phone:703-476-0901
Practice Address - Fax:702-264-9762
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-041522208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB95021Medicare UPIN
VA449552S79Medicare PIN