Individual
DR. KUSUMA KALYANI NANDURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
12255 FAIR LAKES PKWY, KAISER PERMANENTE, FAIRFAX, VA 22033-3952
(703) 934-5700
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101244597
VA
207R00000X
Internal Medicine Physician
D0063439
MD
207R00000X
Internal Medicine Physician
MD040072
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0373330700
—
DC
05
—
409407700
—
MD
01
—
64881302
BCBS MD
—
01
—
J0950013
BCBS DC
—
Enumeration date
09/20/2006
Last updated
05/30/2021
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