Healthcare Provider Details

I. General information

NPI: 1669600862
Provider Name (Legal Business Name): EKTA SRIKUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD LABOR AND DELIVERY C/O DR. THOMAS BURNS
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

4320 SEMINARY RD LABOR AND DELIVERY C/O DR. THOMAS BURNS
ALEXANDRIA VA
22304-1535
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3314
  • Fax:
Mailing address:
  • Phone: 703-504-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101254298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: