Provider Demographics
NPI:1295768240
Name:STEPHEN, SINDU (MD)
Entity type:Individual
Prefix:DR
First Name:SINDU
Middle Name:
Last Name:STEPHEN
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 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:571-291-9786
Practice Address - Street 1:4660 KENMORE AVE STE 305
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-751-5763
Practice Address - Fax:703-370-8704
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036136207R00000X
MDD72949207RG0100X
VA0101265414207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101265414OtherVIRGINIA LICENSE
VA1295768240Medicaid
MDD72949OtherMARYLAND LICENSE