MEDICARE: DR. MAITHILY A. NANDEDKAR M.D

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7985486	OTHER	VA	AETNA
2	192618	OTHER	VA	ANTHEM BCBS
3	4036-0001	OTHER	MD	CAREFIRST BCBS

General Provider Information

NPI Number	:	1558319319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAITHILY A. NANDEDKAR M.D

Provider Business Mailing Address
First Line	:	1801 ROBERT FULTON DR
Second Line	:	SUITE 520
City	:	RESTON
State	:	VA
Zip	:	20191-5461
Country	:	US
Telephone Number	:	703-860-1818
Fax Number	:	703-860-5303

Provider Business Practice Location Address
First Line	:	1801 ROBERT FULTON DR
Second Line	:	SUITE 520
City	:	RESTON
State	:	VA
Zip	:	20191-5461
Country	:	US
Telephone Number	:	703-860-1818
Fax Number	:	703-860-5303

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/21/2007

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Directions to “ DR. MAITHILY A. NANDEDKAR M.D” Practice Location

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