Provider Demographics
NPI:1710944434
Name:RELTON, SUDHAKAR CHANDRAKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHAKAR
Middle Name:CHANDRAKUMAR
Last Name:RELTON
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 1:3400 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9252
Mailing Address - Country:US
Mailing Address - Phone:804-733-6960
Mailing Address - Fax:804-733-3880
Practice Address - Street 1:3400 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9252
Practice Address - Country:US
Practice Address - Phone:804-733-6960
Practice Address - Fax:804-733-3880
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042037207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710944434Medicaid
VA1710944434Medicaid