Provider Demographics
NPI:1710181490
Name:INAMPUDI, SUJAY (MD)
Entity Type:Individual
Prefix:
First Name:SUJAY
Middle Name:
Last Name:INAMPUDI
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 1:104 SELMA DR.
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-678-2800
Mailing Address - Fax:540-678-2859
Practice Address - Street 1:104 SELMA DR.
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:540-678-2859
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66106207R00000X
VA0101249923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101249923OtherLICENSE
MDD66106OtherLICENSE NUMBER