Organization
PENGUIN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. UMESH VENKATA KODU M.D. (PRESIDENT)
(571) 223-2229
Entity
Organization
Contact information
Practice address
44081 PIPELINE PLZ, #125, ASHBURN, VA 20147-5891
(571) 223-2229
(571) 223-3299
Mailing address
44081 PIPELINE PLZ, #125, ASHBURN, VA 20147-5891
(571) 223-2229
(571) 223-3299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101034278
VA
208000000X
Pediatrics Physician
0101243313
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101034278
LICENSE NUMBER
VA
01
—
0101243313
LICENSE NUMBER
VA
Enumeration date
06/05/2009
Last updated
06/05/2009
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