Provider Demographics
NPI:1427022888
Name:SUDHAKAR, KEMPANNA (MD)
Entity type:Individual
Prefix:DR
First Name:KEMPANNA
Middle Name:
Last Name:SUDHAKAR
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 1:7610 CARROLL AVE
Mailing Address - Street 2:STE. 230
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-2303
Mailing Address - Fax:301-891-2487
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:STE. 230
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-2303
Practice Address - Fax:301-891-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019971207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD79871100Medicaid
MD79871100Medicaid
DC416375Medicare ID - Type UnspecifiedDC METRO MEDICARE