Healthcare Provider Details

I. General information

NPI: 1295895431
Provider Name (Legal Business Name): UMESH V KODU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44095 PIPELINE PLAZA SUITE#410
ASHBURN VA
20147-7518
US

IV. Provider business mailing address

44095 PIPELINE PLZ SUITE#410
ASHBURN VA
20147-5898
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-2229
  • Fax: 855-830-1726
Mailing address:
  • Phone: 571-223-2229
  • Fax: 855-830-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101243313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: