Provider Demographics
NPI:1366626814
Name:HEMA A. SUNDARAM, M.D.,P.A
Entity Type:Organization
Organization Name:HEMA A. SUNDARAM, M.D.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-641-9666
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:#630
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-641-9666
Mailing Address - Fax:703-641-9040
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:#205
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-984-3376
Practice Address - Fax:301-984-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044976174400000X
VA0101222212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00601Medicare PIN
G61637Medicare UPIN