MEDICARE: SIVARAMA KRISHNA NANDIPATI MD

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	2084N0400X	Neurology Physician	38160	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G939	OTHER	DC	BLUE CROSS
3	147647	OTHER	VA	BLUE CROSS
4	KEW3NE	OTHER	MD	BLUE CROSS

General Provider Information

NPI Number	:	1528002342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVARAMA KRISHNA NANDIPATI MD

Provider Business Mailing Address
First Line	:	205 S WHITING ST STE 205
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3632
Country	:	US
Telephone Number	:	301-843-2222
Fax Number	:	717-777-8485

Provider Business Practice Location Address
First Line	:	205 S WHITING ST STE 205
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3632
Country	:	US
Telephone Number	:	717-778-4855
Fax Number	:	301-843-2355

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/03/2025

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