Provider Demographics
NPI:1699180646
Name:SIRASATI, UDAYAKIRAN (MD,)
Entity Type:Individual
Prefix:
First Name:UDAYAKIRAN
Middle Name:
Last Name:SIRASATI
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 1:2150 PENSYLVANIA AVENUE NW, 6B-402
Mailing Address - Street 2:MEDICAL FACULTY ASSOCIATES C/O ROBERT PAKAN
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-3157
Mailing Address - Fax:202-741-3285
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-4000
Practice Address - Fax:202-741-3285
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN20438390200000X
DCMTL003337390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program