1396738621 NPI number — SUDAMA S THOLPADY MD

Table of content: SUDAMA S THOLPADY MD (NPI 1396738621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738621 NPI number — SUDAMA S THOLPADY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOLPADY
Provider First Name:
SUDAMA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396738621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 E JEFFERSON ST
Provider Second Line Business Mailing Address:
KAISER PERMANENTE MEDICARE ENROLLMENT
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-816-2424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 ROSEMARY DR
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE MANASSAS MEDICAL CENTER
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-7282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-257-3000
Provider Business Practice Location Address Fax Number:
703-257-3134
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101026010 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 096769 . This is a "BCBS OF VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8524 . This is a "BCBS OF KY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83745 . This is a "SOUTHERN HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019751000 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 197510 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0355933 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64662307 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6466230700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6045880 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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