1225124779 NPI number — DR. RENUKA SOTHINATHAN M.D.

Table of content: DR. RENUKA SOTHINATHAN M.D. (NPI 1225124779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225124779 NPI number — DR. RENUKA SOTHINATHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTHINATHAN
Provider First Name:
RENUKA
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:
1225124779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3930 WALNUT STREET
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-246-9246
Provider Business Mailing Address Fax Number:
703-246-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3930 WALNUT STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-246-9246
Provider Business Practice Location Address Fax Number:
703-246-9257
Provider Enumeration Date:
10/04/2006

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: 207RN0300X , with the licence number:  0101232750 , 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: 010084504 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47430005 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005882842 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010184886 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084512 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084539 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084423 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084474 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084628 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084598 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084610 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084814 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2319484 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010084482 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084440 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084679 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010084792 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4530480 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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