Provider Demographics
NPI:1326142589
Name:PUNJA, SUDHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHAKAR
Middle Name:
Last Name:PUNJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 HANOVER PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2021
Mailing Address - Country:US
Mailing Address - Phone:301-220-1010
Mailing Address - Fax:301-441-8679
Practice Address - Street 1:7219 HANOVER PKWY
Practice Address - Street 2:STE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2021
Practice Address - Country:US
Practice Address - Phone:301-220-1010
Practice Address - Fax:301-441-8679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD002072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1316OtherBCBS
C87879Medicare UPIN
MD1316OtherBCBS