Healthcare Provider Details

I. General information

NPI: 1699180646
Provider Name (Legal Business Name): UDAYAKIRAN SIRASATI M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

2150 PENSYLVANIA AVENUE NW, 6B-402 MEDICAL FACULTY ASSOCIATES C/O ROBERT PAKAN
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax: 202-741-3285
Mailing address:
  • Phone: 202-741-3157
  • Fax: 202-741-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN20438
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMTL003337
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: