Healthcare Provider Details

I. General information

NPI: 1700618725
Provider Name (Legal Business Name): NANDITA K AGHARA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43135 BROADLANDS CENTER PLZ STE 123
BROADLANDS VA
20148-3804
US

IV. Provider business mailing address

43135 BROADLANDS CENTER PLZ STE 123
BROADLANDS VA
20148-3804
US

V. Phone/Fax

Practice location:
  • Phone: 571-206-0742
  • Fax: 571-206-0743
Mailing address:
  • Phone: 571-206-0742
  • Fax: 571-206-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010299
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: