MEDICARE: PRAKASH D. ADAWADKAR, M.D., P.C.

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1932216330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAKASH D. ADAWADKAR, M.D., P.C.

Provider Business Mailing Address
First Line	:	4201 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-670-0300
Fax Number	:	703-670-6759

Provider Business Practice Location Address
First Line	:	4201 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-670-0300
Fax Number	:	703-670-6759

Authorized Official
Title or Position	:	OWNER
Name	:	PRAKASH D. ADAWADKAR
Credential	:	M.D.
Telephone Number	:	703-670-0300

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	05/17/2012

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