MEDICARE: SUKUMARAN C ARYANGAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0015558	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15500001	OTHER	DC	CAREFIRST BLUE CROSS&BLUE

General Provider Information

NPI Number	:	1174576789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKUMARAN C ARYANGAT M.D.

Provider Business Mailing Address
First Line	:	3308 PERRY ST
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-2032
Country	:	US
Telephone Number	:	301-927-3170
Fax Number	:	301-927-0064

Provider Business Practice Location Address
First Line	:	3308 PERRY ST
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-2032
Country	:	US
Telephone Number	:	301-927-3170
Fax Number	:	301-927-0064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/01/2010

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