Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 15704 | MD |
Y | 213EG0000X | General Practice | 15704 | MD |
N | 1223G0001X | General Practice | DEN1001442 | DC |
N | 213EG0000X | General Practice | DEN1001442 | DC |
NPI | 1003216284 |
---|---|
Provider Name | Dr. Manasi Supekar |
First Address | Tysons Corner, VA 22102-3933 |
Second Address | Washington, DC 20019-2662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 24/03/2016 |