Provider Demographics
NPI:1003835091
Name:SUMIDA, NITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:
Last Name:SUMIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1223
Mailing Address - Country:US
Mailing Address - Phone:804-915-4607
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:1760 OLD MEADOW ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2210
Practice Address - Country:US
Practice Address - Phone:703-810-5217
Practice Address - Fax:703-288-7892
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9371416OtherPHCS PROVIDER NUMBER
K169-0001OtherCAREFIRST PROVIDER NUMBER
KY33225OtherKY MEDICAL LICENSE NUMBER
VA169355OtherANTHEM
NC200100613OtherNC MEDICAL LICENSE NUMBER
633048OtherNCPPO PROVIDER NUMBER
7233026OtherAETNA PROVIDER NUMBER
VA0101235316OtherVA MEDICAL LICENSE NUMBER
5456737OtherCIGNA PROVIDER NUMBER
5456737OtherCIGNA PROVIDER NUMBER
9371416OtherPHCS PROVIDER NUMBER