Individual
DR. USHA SUNDARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3700 FETTLER PARK DR, DUMFRIES, VA 22025-2050
(703) 441-7500
(703) 441-7696
Mailing address
3700 FETTLER PARK DR, DUMFRIES, VA 22025-2050
(703) 441-7500
(703) 441-7696
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101054623
VA
208D00000X
General Practice Physician
C1-0012057
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010023165 541581185
—
VA
01
—
C09463
GROUP PTAN
VA
01
—
C09633
GROUP PTAN
VA
Enumeration date
09/08/2006
Last updated
03/28/2024
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