Healthcare Provider Details

I. General information

NPI: 1659531465
Provider Name (Legal Business Name): SUNIL BAJU HARI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

6805 RENITA LN
BETHESDA MD
20817-1548
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4455
  • Fax:
Mailing address:
  • Phone: 301-295-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC165866
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101245974
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29412
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: