Provider Demographics
NPI:1336195734
Name:SUNRISE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAMADITYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-9700
Mailing Address - Street 1:11006 VEIRS MILL RD
Mailing Address - Street 2:PMB 261
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:240-489-6260
Mailing Address - Fax:240-489-6266
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-330-6982
Practice Address - Fax:301-260-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43464207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD174500000Medicaid
G00072Medicare ID - Type UnspecifiedGROUP ID #