Healthcare Provider Details

I. General information

NPI: 1902034655
Provider Name (Legal Business Name): GAYATRI VADDADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6356 HOADLY RD
MANASSAS VA
20112-3422
US

IV. Provider business mailing address

1101 SAM PERRY BOULEVARD SUITE 207
FREDERICKSBURG VA
22401-4453
US

V. Phone/Fax

Practice location:
  • Phone: 703-590-5999
  • Fax: 703-590-5399
Mailing address:
  • Phone: 540-741-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101251908
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: