Provider Demographics
NPI:1043471949
Name:RHEUMATOLOGY AND INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:RHEUMATOLOGY AND INTERNAL MEDICINE, PC
Other - Org Name:SHANMUGAM MUKUNDAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANMUGAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUUKNDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-349-1191
Mailing Address - Street 1:6969 W VILLA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3930 WALNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4738
Practice Address - Country:US
Practice Address - Phone:703-349-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty