Provider Demographics
NPI:1447339122
Name:SURESH GHARSE, MD
Entity type:Organization
Organization Name:SURESH GHARSE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:PURUSHOTTAM
Authorized Official - Last Name:GHARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-355-9975
Mailing Address - Street 1:3900 MONUMENT AVE
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3955
Mailing Address - Country:US
Mailing Address - Phone:804-355-9975
Mailing Address - Fax:804-355-9953
Practice Address - Street 1:3900 MONUMENT AVE
Practice Address - Street 2:SUITE 'A'
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3955
Practice Address - Country:US
Practice Address - Phone:804-355-9975
Practice Address - Fax:804-355-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00800280Medicare ID - Type UnspecifiedSUBMITTER NUMBER