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NPI Code Detail

MEDICARE: DR. USHA SUNDARAM M.D.

MEDICARE: DR. USHA SUNDARAM 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
1208D00000XGeneral Practice PhysicianC1-0012057DE
2208000000XPediatrics Physician0101054623VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C09463OTHERVAGROUP PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3C09633OTHERVAGROUP PTAN

General Provider Information

NPI Number : 1588768907
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. USHA SUNDARAM M.D.
Provider Business Mailing Address
First Line : 3700 FETTLER PARK DR
Second Line :
City : DUMFRIES
State : VA
Zip : 22025-2050
Country : US
Telephone Number : 703-441-7500
Fax Number : 703-441-7696
Provider Business Practice Location Address
First Line : 3700 FETTLER PARK DR
Second Line :
City : DUMFRIES
State : VA
Zip : 22025-2050
Country : US
Telephone Number : 703-441-7500
Fax Number : 703-441-7696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2006
Last Update Date : 03/28/2024

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