Provider Demographics
NPI:1487955399
Name:SODAGAM, ARCHANA (MD)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:SODAGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 THOMAS JOHNSON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4550
Mailing Address - Country:US
Mailing Address - Phone:301-631-6877
Mailing Address - Fax:301-631-2428
Practice Address - Street 1:180 THOMAS JOHNSON DR STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4550
Practice Address - Country:US
Practice Address - Phone:301-631-6877
Practice Address - Fax:301-631-2428
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438870207R00000X, 207RC0000X
MDD89092207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA241698Medicare PIN