Healthcare Provider Details

I. General information

NPI: 1831325117
Provider Name (Legal Business Name): SMITHA REDDY BEERAVOLU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24801 PINEBROOK RD STE 110
CHANTILLY VA
20152-4113
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-722-2500
  • Fax:
Mailing address:
  • Phone: 571-423-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101251937
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10035323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: