Provider Demographics
NPI:1194787531
Name:POWERS, SUZANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:POWERS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1830 TOWN CENTER DR
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3292
Mailing Address - Country:US
Mailing Address - Phone:703-435-3636
Mailing Address - Fax:703-435-3636
Practice Address - Street 1:1830 TOWN CENTER DR
Practice Address - Street 2:SUITE # 205
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3292
Practice Address - Country:US
Practice Address - Phone:703-435-3636
Practice Address - Fax:703-435-9145
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-07-21
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Provider Licenses
StateLicense IDTaxonomies
VA0101236986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH40429Medicare UPIN