Provider Demographics
NPI:1396738621
Name:THOLPADY, SUDAMA S (MD)
Entity type:Individual
Prefix:
First Name:SUDAMA
Middle Name:S
Last Name:THOLPADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10701 ROSEMARY DR
Practice Address - Street 2:KAISER PERMANENTE MANASSAS MEDICAL CENTER
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7282
Practice Address - Country:US
Practice Address - Phone:703-257-3000
Practice Address - Fax:703-257-3134
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101026010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
096769OtherBCBS OF VA
8524OtherBCBS OF KY
83745OtherSOUTHERN HEALTH SERVICES
019751000OtherDEPT OF LABOR
197510OtherBLACK LUNG
0355933OtherUMWA
KY64662307Medicaid
KY6466230700Medicaid
VA6045880Medicaid
8524OtherBCBS OF KY
B09563Medicare UPIN
096769OtherBCBS OF VA
019751000OtherDEPT OF LABOR
KY64662307Medicaid