Active NPI
Patcharin Surichamorn, M.D.
- Pediatrics Physician
- Baltimore, MD
National Provider Identifier
1205869336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0017134
- Practice address
- 4 W Rolling Crossroads
Suite 100
Baltimore, MD 21228-6280 - Phone
- (410) 869-0100
- Fax
- (410) 869-0460
- NPI assigned
- Jul 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0017134 | MD | Primary |
Addresses
Primary practice location
4 W Rolling Crossroads
Suite 100
Baltimore, MD 21228-6280
Mailing address
3 Brookfield Garth
Lutherville, MD 21093-4735
Phone (410) 869-0100
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2330356 | Other | AETNA HMO | |
| 7360111 | Other | AETNA PPO | |
| 1980499 | Other | UNITED HEALTHCARE | |
| 54847 | Medicaid | MD | |
| 76883501 | Other | CAREFIRST MARYLAND | |
| 9628375001 | Other | CIGNA | |
| 9984 | Other | KAISER | |
| 0035 | Other | CAREFIRST DC | |
| 112468 | Other | COVENTRY | |
| 700248 | Other | NCPPO | |
| 039588 | Other | JOHNS HOPKINS HEALTHCARE | |
| 281958 | Other | MAMSI | |
| 757361800 | Medicaid | MD | |
| 1980499 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifebridge Community Physicians, Inc | Past | Accepting new patients | |
| Potomac Physicians PA | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pulmonary Disease Physician
- Pikesville, MD
- NPI 1306182621
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1205869336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 BROOKFIELD GARTH",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "210934735",
"telephone_number": "410-869-0100",
"fax_number": "410-869-0460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 W ROLLING CROSSROADS",
"address_2": "SUITE 100",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212286280",
"telephone_number": "410-869-0100",
"fax_number": "410-869-0460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURICHAMORN",
"first_name": "PATCHARIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0017134",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2330356",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "7360111",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1980499",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54847",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST MARYLAND",
"identifier": "76883501",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "9628375001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "9984",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST DC",
"identifier": "0035",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "112468",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPPO",
"identifier": "700248",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHNS HOPKINS HEALTHCARE",
"identifier": "039588",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "281958",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "757361800",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1980499",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.