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Individual

DR. RATIH B SUDHARTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
201 N WASHINGTON ST, FALLS CHURCH, VA 22046-4518
(703) 237-4000
Mailing address
201 N WASHINGTON ST, FALLS CHURCH, VA 22046-4518

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101246929
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1071992
WORKERS COMPENSATION
WV
05
3810009609
WV
01
550525724007
TRICARE CHAMPUS
WV
01
B682
BLUE CROSS BLUE SHIELD
Enumeration date
05/14/2007
Last updated
03/29/2022
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