1649706193 NPI number — DR. SOORYA NAMBOODIRI AGGARWAL DO

Table of content: DR. SOORYA NAMBOODIRI AGGARWAL DO (NPI 1649706193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649706193 NPI number — DR. SOORYA NAMBOODIRI AGGARWAL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGGARWAL
Provider First Name:
SOORYA
Provider Middle Name:
NAMBOODIRI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAMBOODIRI
Provider Other First Name:
SOORYA
Provider Other Middle Name:
KRISHNAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649706193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10770 COLUMBIA PIKE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20901-4462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-589-9012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15001 SHADY GROVE RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-340-3252
Provider Business Practice Location Address Fax Number:
301-340-1423
Provider Enumeration Date:
05/03/2017

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:  OT017722 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: H0092882 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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