Provider Demographics
NPI:1487604039
Name:TULSI, PRIYADARSHAN K (MD)
Entity type:Individual
Prefix:
First Name:PRIYADARSHAN
Middle Name:K
Last Name:TULSI
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:PO BOX 748613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9430 FORESTWOOD LN
Practice Address - Street 2:100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4753
Practice Address - Country:US
Practice Address - Phone:703-365-0227
Practice Address - Fax:703-365-0332
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2399249OtherUNITED HEALTHCARE
VA5625017OtherFIRST HEALTH/CCN
VAB337-0003OtherCARE FIRST BLUE CROSS
VA010128234Medicaid
VA708975OtherNCPPO
VA8132829OtherMAMSI
VA7015450OtherAETNA PROVIDER NUMBER