Healthcare Provider Details

I. General information

NPI: 1033121058
Provider Name (Legal Business Name): RAMA PRAYAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5194 DAWES AVE
ALEXANDRIA VA
22311-1402
US

IV. Provider business mailing address

PO BOX 11139
MC LEAN VA
22102-9139
US

V. Phone/Fax

Practice location:
  • Phone: 703-820-1900
  • Fax: 866-528-6229
Mailing address:
  • Phone: 301-674-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD51906
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD51906
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD51906
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD51906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: