=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851312995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUCHITHRA A NANCHERLA M. D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 01/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 W BROAD ST SUITE# 120
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-4235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-534-6002
-----------------------------------------------------
Fax | 703-534-7472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 W BROAD ST SUITE# 120
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-4235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-534-6002
-----------------------------------------------------
Fax | 703-534-7472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 010141874
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------