Provider Demographics
NPI:1912067133
Name:KUSUMADHARAGOWDA, MURLIYA LINGAPPA (MD)
Entity Type:Individual
Prefix:
First Name:MURLIYA
Middle Name:LINGAPPA
Last Name:KUSUMADHARAGOWDA
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 1:747 ALABAMA AVE SOUTHEAST
Mailing Address - Street 2:#1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4150
Mailing Address - Country:US
Mailing Address - Phone:202-563-1000
Mailing Address - Fax:202-563-3500
Practice Address - Street 1:747 ALABAMA AVE SOUTHEAST
Practice Address - Street 2:#1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4150
Practice Address - Country:US
Practice Address - Phone:202-563-1000
Practice Address - Fax:202-563-3500
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC13043208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93152Medicare UPIN