Provider Demographics
NPI:1295895431
Name:KODU, UMESH V (MD)
Entity type:Individual
Prefix:MR
First Name:UMESH
Middle Name:V
Last Name:KODU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:44095 PIPELINE PLZ
Mailing Address - Street 2:SUITE#410
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5898
Mailing Address - Country:US
Mailing Address - Phone:571-223-2229
Mailing Address - Fax:855-830-1726
Practice Address - Street 1:44095 PIPELINE PLAZA
Practice Address - Street 2:SUITE#410
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7518
Practice Address - Country:US
Practice Address - Phone:571-223-2229
Practice Address - Fax:855-830-1726
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-10-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101243313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50199Medicare UPIN