Provider Demographics
NPI:1225124779
Name:SOTHINATHAN, RENUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:SOTHINATHAN
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 1:3930 WALNUT STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4738
Mailing Address - Country:US
Mailing Address - Phone:703-246-9246
Mailing Address - Fax:703-246-9257
Practice Address - Street 1:3930 WALNUT STREET
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:703-246-9246
Practice Address - Fax:703-246-9257
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232750207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010084504Medicaid
47430005OtherCAREFIRST
VA005882842Medicaid
VA010184886Medicaid
VA010084512Medicaid
VA010084539Medicaid
VA010084423Medicaid
VA010084474Medicaid
VA010084628Medicaid
VA010084598Medicaid
VA010084610Medicaid
VA010084814Medicaid
2319484OtherUNITED HEALTHCARE
VA010084482Medicaid
VA010084440Medicaid
VA010084679Medicaid
VA010084792Medicaid
4530480OtherCIGNA
VA010084679Medicaid
VA010084504Medicaid