Provider Demographics
NPI:1548478712
Name:SANDESARA, RINKU MEHRA (MD)
Entity type:Individual
Prefix:DR
First Name:RINKU
Middle Name:MEHRA
Last Name:SANDESARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RINKU
Other - Middle Name:
Other - Last Name:MEHRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:278 CEDAR LN SE # 4032
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6613
Mailing Address - Country:US
Mailing Address - Phone:703-940-0635
Mailing Address - Fax:703-952-7685
Practice Address - Street 1:278 CEDAR LN SE # 4032
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6613
Practice Address - Country:US
Practice Address - Phone:703-940-0635
Practice Address - Fax:703-952-7685
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012431562080P0205X
IA35623208000000X
MDD00674472080P0205X
DCMD0371982080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54576OtherWELLMARK BCBS
IAI20421Medicare PIN