Phillip Barry Surosky, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

7474 Issued in MD

Practice address

4821 Butler Road
2B
Glyndon, MD 21071

Phone

(410) 833-6200

Fax

(410) 833-6365

NPI assigned

Mar 9, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mark J Nesbitt DDS LLC

  • General Practice Dentistry
  • Glyndon, MD
  • NPI 1619724747
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1851422893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4821 BUTLER ROAD",
            "address_2": "2B",
            "city": "GLYNDON",
            "state": "MD",
            "postal_code": "21071",
            "telephone_number": "410-833-6200",
            "fax_number": "410-833-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4821 BUTLER ROAD",
            "address_2": "2B",
            "city": "GLYNDON",
            "state": "MD",
            "postal_code": "21071",
            "telephone_number": "410-833-6200",
            "fax_number": "410-833-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUROSKY",
        "first_name": "PHILLIP",
        "middle_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "7474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "521400959",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Glyndon, MD
• Providers in Glyndon, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.