Provider Demographics
NPI:1861713398
Name:SUAAVA, ROSE GUNTER (DO)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:GUNTER
Last Name:SUAAVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:A
Other - Last Name:DULANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:446 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8672
Mailing Address - Country:US
Mailing Address - Phone:252-435-1275
Mailing Address - Fax:855-348-4480
Practice Address - Street 1:446 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8672
Practice Address - Country:US
Practice Address - Phone:252-435-1275
Practice Address - Fax:855-348-4480
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203893207Q00000X
KS7464207Q00000X
NC2020-03128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVJ889B288Medicare PIN