Healthcare Provider Details

I. General information

NPI: 1972009827
Provider Name (Legal Business Name): ADITYA SHITALKUMAR RALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 05/22/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PENNSYLVANIA AVE SE STE 200
WASHINGTON DC
20003-4361
US

IV. Provider business mailing address

1785 HOLLY OAK LN
CHATTANOOGA TN
37421-3497
US

V. Phone/Fax

Practice location:
  • Phone: 202-331-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number98735
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD210001930
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number98735
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: