Healthcare Provider Details

I. General information

NPI: 1548555998
Provider Name (Legal Business Name): SHUBHA VENKATESH SRINIVAS M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHUBHA VENKATESH M.D., M.P.H.

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD STE 350
ANNANDALE VA
22003-7357
US

IV. Provider business mailing address

3289 WOODBURN RD STE 350
ANNANDALE VA
22003-7357
US

V. Phone/Fax

Practice location:
  • Phone: 703-641-8616
  • Fax:
Mailing address:
  • Phone: 703-641-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101255218
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101255218
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101255218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: