Healthcare Provider Details

I. General information

NPI: 1275850224
Provider Name (Legal Business Name): ANJULI SRIVASTAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 ARLINGTON BLVD STE. 210
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

6565 ARLINGTON BLVD STE. 210
FALLS CHURCH VA
22042-3013
US

V. Phone/Fax

Practice location:
  • Phone: 703-536-7763
  • Fax: 703-536-1000
Mailing address:
  • Phone: 703-534-1000
  • Fax: 703-536-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101255957
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD464271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: