Provider Demographics
NPI:1578581369
Name:SUMIDA, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SUMIDA
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:PO BOX 75420
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5420
Mailing Address - Country:US
Mailing Address - Phone:703-383-6469
Mailing Address - Fax:
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 310
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3616
Practice Address - Country:US
Practice Address - Phone:703-525-6100
Practice Address - Fax:703-525-6131
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235315207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010135885Medicaid
P00251146OtherMEDICARE RAILROAD
CA2348OtherMEDICARE RAILROAD
0962280007Medicare NSC
0962280002Medicare NSC
VA010135885Medicaid
0962280007Medicare NSC