MEDICARE: DR. SUJATA H. AMBARDAR 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	207RI0200X	Infectious Disease Physician	0101053019	VA

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

General Provider Information

NPI Number	:	1194778027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUJATA H. AMBARDAR M.D.

Provider Business Mailing Address
First Line	:	3289 WOODBURN RD
Second Line	:	SUITE # 200
City	:	ANNANDALE
State	:	VA
Zip	:	22003-6800
Country	:	US
Telephone Number	:	703-560-7900
Fax Number	:	703-560-8408

Provider Business Practice Location Address
First Line	:	3289 WOODBURN RD
Second Line	:	SUITE # 200
City	:	ANNANDALE
State	:	VA
Zip	:	22003-6800
Country	:	US
Telephone Number	:	703-560-7900
Fax Number	:	703-560-8408

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/13/2008

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