Provider Demographics
NPI:1578258653
Name:KATHIRVELU, SURYA
Entity Type:Individual
Prefix:
First Name:SURYA
Middle Name:
Last Name:KATHIRVELU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26461 MORGANS CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1271
Mailing Address - Country:US
Mailing Address - Phone:571-443-7086
Mailing Address - Fax:
Practice Address - Street 1:6319 CASTLE PL STE 3A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1907
Practice Address - Country:US
Practice Address - Phone:571-830-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF03230752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily