Healthcare Provider Details

I. General information

NPI: 1982459020
Provider Name (Legal Business Name): ADARSHVARDHAN TANGELLA M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 07/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST. NW MEDSTAR WASHINGTON HOSPITAL CENTRE, DEPARTMENT OF INTER
WASHINGTON DC
20010
US

IV. Provider business mailing address

110 IRVING ST. NW MEDSTAR WASHINGTON HOSPITAL CENTRE, DEPARTMENT OF INTER
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8271
  • Fax: 202-877-6292
Mailing address:
  • Phone: 202-877-8271
  • Fax: 202-877-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: