Healthcare Provider Details

I. General information

NPI: 1336589829
Provider Name (Legal Business Name): NADIRA RAMKELLAWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-6044
  • Fax:
Mailing address:
  • Phone: 703-858-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101260247
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number0101260247
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101260247
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: