Provider Demographics
NPI:1154522688
Name:EDMOND, SURA U (MD)
Entity type:Individual
Prefix:DR
First Name:SURA
Middle Name:U
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:STE 102
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-1100
Mailing Address - Country:US
Mailing Address - Phone:240-245-0821
Mailing Address - Fax:240-252-2141
Practice Address - Street 1:4379 RIDGEWOOD CENTER DR
Practice Address - Street 2:STE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8322
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0082246207V00000X
VA0101247964207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154522688Medicaid
VAC06778OtherGROUP PTAN