Healthcare Provider Details

I. General information

NPI: 1770658668
Provider Name (Legal Business Name): MADHUSUDAN G RAJURKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FETTLER PARK DR
DUMFRIES VA
22025-2050
US

IV. Provider business mailing address

16490 STEDHAM CIR APT 103
DUMFRIES VA
22025-2101
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-8901
  • Fax: 757-314-8934
Mailing address:
  • Phone: 703-223-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101036201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: