Healthcare Provider Details

I. General information

NPI: 1174191555
Provider Name (Legal Business Name): AMEETA ASHOK KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10686 CRESTWOOD DR STE A
MANASSAS VA
20109-4407
US

IV. Provider business mailing address

10686 CRESTWOOD DR STE A
MANASSAS VA
20109-4407
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-9773
  • Fax:
Mailing address:
  • Phone: 703-214-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101288216
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: