Provider Demographics
NPI:1528149689
Name:SOOD, RAKESH K (MD)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:K
Last Name:SOOD
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 1:436 CLAIRMONT COURT, STE 105
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:434-348-4422
Mailing Address - Fax:434-348-4423
Practice Address - Street 1:727 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847
Practice Address - Country:US
Practice Address - Phone:434-348-4422
Practice Address - Fax:434-348-4423
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010426452084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA301216OtherANTHEM BLUE CROSS BLUE SHIELD OF VA
VA007100086 541581185Medicaid
VA1528149689Medicaid
VA1528149689Medicaid
VA301216OtherANTHEM BLUE CROSS BLUE SHIELD OF VA
VAA17098Medicare UPIN