MEDICARE: MADHUSUDHAN REDDY KASIPATHY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401414354	VA
2	122300000X	Dentist	DS037550	PA

General Provider Information

NPI Number	:	1316100639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHUSUDHAN REDDY KASIPATHY DDS

Provider Business Mailing Address
First Line	:	13206 FOX RIPPLE LN
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-3042
Country	:	US
Telephone Number	:	848-667-0516
Fax Number	:

Provider Business Practice Location Address
First Line	:	8353 GREENSBORO DR STE A&B
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3530
Country	:	US
Telephone Number	:	848-667-0516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	08/10/2015

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