Provider Demographics
NPI:1164093282
Name:SURESH, MITHIL GOWDA (MD)
Entity type:Individual
Prefix:
First Name:MITHIL GOWDA
Middle Name:
Last Name:SURESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ANTIETAM DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICA
Mailing Address - State:DE
Mailing Address - Zip Code:19946-2661
Mailing Address - Country:US
Mailing Address - Phone:508-651-6566
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0018794207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology