Provider Demographics
NPI:1871813873
Name:KANJERLA, KIRAN KUMAR (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:KUMAR
Last Name:KANJERLA
Suffix:
Gender:M
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:THE GW MEDICAL FACULTY ASSOCIATES
Mailing Address - Street 2:2150 PENNSYLVANIA AVE , NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-741-3000
Mailing Address - Fax:
Practice Address - Street 1:THE GW MEDICAL FACULTY ASSOCIATES
Practice Address - Street 2:2150 PENNSYLVANIA AVE , NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-741-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL004823390200000X
MI4301096210390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program