Healthcare Provider Details

I. General information

NPI: 1003835091
Provider Name (Legal Business Name): NITA SUMIDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW ROAD SUITE 500
MCLEAN VA
22102-2210
US

IV. Provider business mailing address

1115 BOULDERS PARKWAY SUITE 200
NORTH CHESTERFIELD VA
23225-1223
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5217
  • Fax: 703-288-7892
Mailing address:
  • Phone: 804-915-4607
  • Fax: 804-968-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101235316
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: