Healthcare Provider Details

I. General information

NPI: 1336195734
Provider Name (Legal Business Name): SUNRISE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RESEARCH BLVD SUITE 350
ROCKVILLE MD
20850-3215
US

IV. Provider business mailing address

11006 VEIRS MILL RD PMB 261
WHEATON MD
20902-2582
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-6982
  • Fax: 301-260-2838
Mailing address:
  • Phone: 240-489-6260
  • Fax: 240-489-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD43464
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD43464
License Number StateMD

VIII. Authorized Official

Name: VIKRAMADITYA D REDDY
Title or Position: PRIMARY PARTNER
Credential: M.D.
Phone: 301-570-9700