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NPI Code Detail

MEDICARE: DR. SHANTHARAMA KARANTH MD

MEDICARE: DR. SHANTHARAMA KARANTH 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
12080N0001XNeonatal-Perinatal Medicine Physician0101042860VA

General Provider Information

NPI Number : 1700883980
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANTHARAMA KARANTH MD
Provider Business Mailing Address
First Line : 9241 RAINBOW FALLS DR
Second Line :
City : BRISTOW
State : VA
Zip : 20136-2137
Country : US
Telephone Number : 703-361-4199
Fax Number : 703-369-8234
Provider Business Practice Location Address
First Line : 8700 SUDLEY RD
Second Line :
City : MANASSAS
State : VA
Zip : 20110-4418
Country : US
Telephone Number : 703-369-8134
Fax Number : 703-369-8234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2005
Last Update Date : 07/08/2007

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