Healthcare Provider Details

I. General information

NPI: 1750602389
Provider Name (Legal Business Name): SRIKANTH MAHAVADI, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 POCAHONTAS TRAIL SUITE #F
PROVIDENCE FORGE VA
23140-0357
US

IV. Provider business mailing address

PO BOX 357
PROVIDENCE FORGE VA
23140-0357
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-8350
  • Fax: 804-966-8999
Mailing address:
  • Phone: 804-966-8350
  • Fax: 805-966-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SRIKANTH MAHAVADI
Title or Position: PRESIDENT
Credential: DPM
Phone: 804-966-8350