Healthcare Provider Details

I. General information

NPI: 1750817797
Provider Name (Legal Business Name): PRANAVI VEMURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN STE 508
ALEXANDRIA VA
22310-3251
US

IV. Provider business mailing address

833 CHESTNUT STREET
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-7633
  • Fax: 703-971-0097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101272690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: