Provider Demographics
NPI:1891801460
Name:ATTANAGODA, KUMUDINI (MD)
Entity Type:Individual
Prefix:
First Name:KUMUDINI
Middle Name:
Last Name:ATTANAGODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1964
Mailing Address - Country:US
Mailing Address - Phone:202-885-5668
Mailing Address - Fax:
Practice Address - Street 1:4228 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2138
Practice Address - Country:US
Practice Address - Phone:202-885-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD328452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47890Medicare UPIN
010765P23Medicare ID - Type Unspecified