Basic Information
| Provider Information | |||||||||
| NPI: | 1871085175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PODDER | ||||||||
| FirstName: | SHREYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, NPT-2 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037763582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, NPT-2 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037763582 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116031487 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | 75062-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.