Provider Demographics
NPI:1851747885
Name:KEMPANNASUDHAKAR,MD,PC
Entity Type:Organization
Organization Name:KEMPANNASUDHAKAR,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEMPANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDHAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-2303
Mailing Address - Street 1:7610 CARROLL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6312
Mailing Address - Country:US
Mailing Address - Phone:301-891-2303
Mailing Address - Fax:301-891-2487
Practice Address - Street 1:7610 CARROLL AVE STE 230
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6312
Practice Address - Country:US
Practice Address - Phone:301-891-2303
Practice Address - Fax:301-891-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 19971261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94795Medicare UPIN