Provider Demographics
NPI:1689730848
Name:SENERICHES, LIANA SUSTENTO (DO)
Entity Type:Individual
Prefix:DR
First Name:LIANA
Middle Name:SUSTENTO
Last Name:SENERICHES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758963
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8963
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:47100 COMMUNITY PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-1826
Practice Address - Country:US
Practice Address - Phone:703-880-1403
Practice Address - Fax:703-880-1404
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA9628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV4631AMedicare PIN
VA147239YWAUMedicare PIN