Provider Demographics
NPI:1386887677
Name:JOSEPH, SUNIL PANUVELIL (MBBS)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:PANUVELIL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5102
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-426-2359
Practice Address - Fax:570-420-2479
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449007207L00000X, 207LP3000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102848260Medicaid
PA102848260Medicaid