Healthcare Provider Details

I. General information

NPI: 1699753442
Provider Name (Legal Business Name): MAHESH SARMA PARAMESWARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19490 SANDRIDGE WAY STE 230
LEESBURG VA
20176-3467
US

IV. Provider business mailing address

224D CORNWALL ST NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5885
  • Fax: 703-858-5001
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101232845
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: