Provider Demographics
NPI:1487831681
Name:JAYARAJ-SUDARSAN, SUJITHRA (MD)
Entity Type:Individual
Prefix:
First Name:SUJITHRA
Middle Name:
Last Name:JAYARAJ-SUDARSAN
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 1:507 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2506
Mailing Address - Country:US
Mailing Address - Phone:301-840-1200
Mailing Address - Fax:301-840-9253
Practice Address - Street 1:507 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2506
Practice Address - Country:US
Practice Address - Phone:301-840-1200
Practice Address - Fax:301-840-9253
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301083176OtherEDUCATIONAL LICENSE