Healthcare Provider Details

I. General information

NPI: 1982901732
Provider Name (Legal Business Name): SWARUPA ESANAKULA ,MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE 103
LANSDOWNE VA
20176-8452
US

IV. Provider business mailing address

2343 CYPRESS COVE CIR 102
HERNDON VA
20171-2884
US

V. Phone/Fax

Practice location:
  • Phone: 703-953-2665
  • Fax:
Mailing address:
  • Phone: 703-955-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101243596
License Number StateVA

VIII. Authorized Official

Name: DR. SWARUPA ESANAKULA
Title or Position: M.D
Credential: M.D
Phone: 703-955-2695