Healthcare Provider Details

I. General information

NPI: 1699842187
Provider Name (Legal Business Name): SRINAGESH PALUVOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE SUITE #210
LANSDOWNE VA
20176-8452
US

IV. Provider business mailing address

19415 DEERFIELD AVE SUITE #210
LANSDOWNE VA
20176-8452
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-8830
  • Fax: 703-729-8477
Mailing address:
  • Phone: 703-729-8830
  • Fax: 703-729-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0101059099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: