Provider Demographics
NPI:1770563611
Name:MUKHARA, HEMALATHA (MD)
Entity type:Individual
Prefix:MRS
First Name:HEMALATHA
Middle Name:
Last Name:MUKHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HEMALATHA
Other - Middle Name:
Other - Last Name:NARASIMHALU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-369-8055
Mailing Address - Fax:703-369-8565
Practice Address - Street 1:8680 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4287
Practice Address - Country:US
Practice Address - Phone:703-369-8055
Practice Address - Fax:703-369-8565
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012415322084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770563611Medicaid
VA1770563611Medicaid
VA017619P82Medicare PIN
H90473Medicare UPIN