Provider Demographics
NPI:1982901732
Name:SWARUPA ESANAKULA ,MD PC
Entity type:Organization
Organization Name:SWARUPA ESANAKULA ,MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:SWARUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESANAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-955-2695
Mailing Address - Street 1:2343 CYPRESS COVE CIR
Mailing Address - Street 2:102
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2884
Mailing Address - Country:US
Mailing Address - Phone:703-955-2695
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:103
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-953-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty