Healthcare Provider Details

I. General information

NPI: 1174502132
Provider Name (Legal Business Name): APPAJI GONDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SPRING HILL RD STE 350
MC LEAN VA
22102-3006
US

IV. Provider business mailing address

1420 SPRING HILL RD STE 350
MC LEAN VA
22102-3006
US

V. Phone/Fax

Practice location:
  • Phone: 703-790-9722
  • Fax: 703-893-8666
Mailing address:
  • Phone: 703-790-9722
  • Fax: 703-893-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101240011
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD036216
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: