Healthcare Provider Details

I. General information

NPI: 1780048264
Provider Name (Legal Business Name): ARUN NAG SANTHOSH MALLAPAREDDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 HAMAKER CT STE 350
FAIRFAX VA
22031-2243
US

IV. Provider business mailing address

3025 HAMAKER CT STE 350
FAIRFAX VA
22031-2243
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-6400
  • Fax: 703-641-5821
Mailing address:
  • Phone: 703-573-6400
  • Fax: 703-641-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0101283107
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101283107
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.139042
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: