Provider Demographics
NPI:1023007564
Name:DHARIA, SUBARNA B (MD)
Entity Type:Individual
Prefix:
First Name:SUBARNA
Middle Name:B
Last Name:DHARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUBARNA
Other - Middle Name:
Other - Last Name:BASU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Mailing Address - Street 2:STE. H
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171
Mailing Address - Country:US
Mailing Address - Phone:703-860-4200
Mailing Address - Fax:703-860-1528
Practice Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Practice Address - Street 2:STE. H
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-860-4200
Practice Address - Fax:703-860-1528
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010167311Medicaid
I31706Medicare UPIN
VA007719E54Medicare ID - Type Unspecified