Healthcare Provider Details

I. General information

NPI: 1104929462
Provider Name (Legal Business Name): VIVEK P SINHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S WEST ST SUITE 204
ALEXANDRIA VA
22314-2858
US

IV. Provider business mailing address

3714 IVANHOE LN
ALEXANDRIA VA
22310-2156
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-5603
  • Fax: 703-348-5603
Mailing address:
  • Phone: 516-810-4662
  • Fax: 703-348-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0066720
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101255878
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD042074
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: