Healthcare Provider Details

I. General information

NPI: 1619416757
Provider Name (Legal Business Name): RAMINENI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
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: 202-288-0285
  • Fax: 202-785-1370
Mailing address:
  • Phone: 202-288-0285
  • Fax: 202-785-4187

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: DR. PRAFUL RAMINENI
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 202-288-0285