Provider Demographics
NPI:1386731172
Name:SANKARAN, KUMARESAN (MD)
Entity type:Individual
Prefix:
First Name:KUMARESAN
Middle Name:
Last Name:SANKARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 OLD LEE HWY STE 210B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4367
Mailing Address - Country:US
Mailing Address - Phone:703-876-6131
Mailing Address - Fax:703-876-6009
Practice Address - Street 1:2812 OLD LEE HWY STE 210B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4367
Practice Address - Country:US
Practice Address - Phone:703-876-6131
Practice Address - Fax:703-876-6009
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78095Medicare UPIN