Provider Demographics
NPI:1962045542
Name:KUMARESANSANKARAN,MD,PC
Entity Type:Organization
Organization Name:KUMARESANSANKARAN,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMARESAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-876-6131
Mailing Address - Street 1:2812 OLD LEE HWY STE 210B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4367
Mailing Address - Country:US
Mailing Address - Phone:703-876-6131
Mailing Address - Fax:
Practice Address - Street 1:2812 OLD LEE HWY STE 210B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4367
Practice Address - Country:US
Practice Address - Phone:703-876-6131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care