Healthcare Provider Details

I. General information

NPI: 1174458194
Provider Name (Legal Business Name): TABULA MEDICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 103
LANSDOWNE VA
20176-8470
US

IV. Provider business mailing address

19415 DEERFIELD AVE STE 103
LANSDOWNE VA
20176-8470
US

V. Phone/Fax

Practice location:
  • Phone: 703-957-8205
  • Fax: 571-223-3834
Mailing address:
  • Phone: 703-957-8205
  • Fax: 571-223-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJIV KUMAR AGGARWAL
Title or Position: CEO
Credential:
Phone: 703-732-5625