Provider Demographics
NPI:1871535302
Name:EASWARAN, SUMITRA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMITRA
Middle Name:
Last Name:EASWARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:43480 YUKON DR STE 100
Practice Address - Street 2:KAISER PERMANENTE ASHBURN MEDICAL CENTER
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6988
Practice Address - Country:US
Practice Address - Phone:571-252-6000
Practice Address - Fax:571-252-6011
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0072428207R00000X
VA0101242702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2558905Medicaid
OH000000360994OtherANTHEM
OH5993114OtherCIGNA
OHR85053OtherSUMMACARE
OHI32395Medicare UPIN
OHR85053OtherSUMMACARE