Healthcare Provider Details

I. General information

NPI: 1003977604
Provider Name (Legal Business Name): PRAFUL MARUTI RAMINENI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW SUITE 200
WASHINGTON DC
20037-1404
US

IV. Provider business mailing address

6537 SOTHORON RD
MC LEAN VA
22101-3022
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-4187
  • Fax: 202-785-1370
Mailing address:
  • Phone: 202-288-0285
  • Fax: 202-785-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD036474
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: