Provider Demographics
NPI:1538328844
Name:SUKUMARAN, NISHANTH (MD)
Entity Type:Individual
Prefix:
First Name:NISHANTH
Middle Name:
Last Name:SUKUMARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-2024
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:210 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9338
Practice Address - Country:US
Practice Address - Phone:804-431-1100
Practice Address - Fax:804-862-1094
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD434764207R00000X, 208M00000X
VA0101254006207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV9830BMedicare PIN
VAVV9830AMedicare PIN