Basic Information
| Provider Information | |||||||||
| NPI: | 1396738621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOLPADY | ||||||||
| FirstName: | SUDAMA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10701 ROSEMARY DR | ||||||||
| Address2: | KAISER PERMANENTE MANASSAS MEDICAL CENTER | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201097282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032573000 | ||||||||
| FaxNumber: | 7032573134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 11/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101026010 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 096769 | 01 | BCBS OF VA | OTHER | 8524 | 01 | BCBS OF KY | OTHER | 83745 | 01 | SOUTHERN HEALTH SERVICES | OTHER | 019751000 | 01 | DEPT OF LABOR | OTHER | 197510 | 01 | BLACK LUNG | OTHER | 0355933 | 01 | UMWA | OTHER | 64662307 | 05 | KY | MEDICAID | 6466230700 | 05 | KY | MEDICAID | 6045880 | 05 | VA | MEDICAID |