Provider Demographics
NPI:1447201751
Name:SUNDARAM, SUBODHKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SUBODHKUMAR
Middle Name:
Last Name:SUNDARAM
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 1:4019 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2606
Mailing Address - Country:US
Mailing Address - Phone:703-996-9964
Mailing Address - Fax:703-996-9964
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-996-9964
Practice Address - Fax:703-996-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250515207RC0200X
DCMD037619207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine