Provider Demographics
NPI:1417144379
Name:SUCHARITHA VIGNESHWAR MD PLLC
Entity Type:Organization
Organization Name:SUCHARITHA VIGNESHWAR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-5001
Mailing Address - Street 1:7603 FOREST AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4944
Mailing Address - Country:US
Mailing Address - Phone:804-282-5001
Mailing Address - Fax:
Practice Address - Street 1:7603 FOREST AVE., SUITE 407
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-1922
Practice Address - Country:US
Practice Address - Phone:804-282-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006216781Medicaid
VAG80321Medicare UPIN