1003835091 NPI number — DR. NITA SUMIDA M.D.

Table of content: DR. NITA SUMIDA M.D. (NPI 1003835091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003835091 NPI number — DR. NITA SUMIDA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMIDA
Provider First Name:
NITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1003835091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 BOULDERS PARKWAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-915-4607
Provider Business Mailing Address Fax Number:
804-968-1803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 OLD MEADOW ROAD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
MCLEAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22102-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-810-5217
Provider Business Practice Location Address Fax Number:
703-288-7892
Provider Enumeration Date:
07/19/2006

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: 174400000X , with the licence number:  0101235316 , 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: 9371416 . This is a "PHCS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: K169-0001 . This is a "CAREFIRST PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33225 . This is a "KY MEDICAL LICENSE NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 169355 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 200100613 . This is a "NC MEDICAL LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 633048 . This is a "NCPPO PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7233026 . This is a "AETNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0101235316 . This is a "VA MEDICAL LICENSE NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5456737 . This is a "CIGNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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