Healthcare Provider Details

I. General information

NPI: 1548098791
Provider Name (Legal Business Name): VAISHNAVI N ENAGANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

1175 ALSACE DR
APEX NC
27502-5273
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax:
Mailing address:
  • Phone: 404-514-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116042182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: