Healthcare Provider Details

I. General information

NPI: 1871548255
Provider Name (Legal Business Name): VIJAYA L SUNKARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21170 ASHBY PONDS BLVD
ASHBURN VA
20147-6128
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 571-291-6131
  • Fax: 571-291-6135
Mailing address:
  • Phone: 571-291-6131
  • Fax: 571-291-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101228282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: