Healthcare Provider Details

I. General information

NPI: 1043058373
Provider Name (Legal Business Name): SUJITHA CHOUGANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

1515 RICHMOND HIGHWAY CRYSTAL SQUARE APARTMENTS, APT# 1008
ARLINGTON VA
22202-3314
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 571-287-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMTL600001816
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: