Healthcare Provider Details

I. General information

NPI: 1639439334
Provider Name (Legal Business Name): SHARMILA P DHULIPALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S VAN DORN ST APT C-219
ALEXANDRIA VA
22304-4341
US

IV. Provider business mailing address

1150 VARNUM ST NE
WASHINGTON DC
20017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 571-484-6470
  • Fax:
Mailing address:
  • Phone: 202-269-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201650
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: