Healthcare Provider Details

I. General information

NPI: 1063568061
Provider Name (Legal Business Name): LALITHA S RAMBHALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E GLEBE RD
ALEXANDRIA VA
22305-2938
US

IV. Provider business mailing address

2 E GLEBE RD
ALEXANDRIA VA
22305-2938
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-5568
  • Fax: 703-535-1583
Mailing address:
  • Phone: 703-535-5568
  • Fax: 703-535-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101045815
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: