Healthcare Provider Details

I. General information

NPI: 1558319319
Provider Name (Legal Business Name): MAITHILY A. NANDEDKAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROBERT FULTON DR SUITE 520
RESTON VA
20191-5461
US

IV. Provider business mailing address

1801 ROBERT FULTON DR SUITE 520
RESTON VA
20191-5461
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-1818
  • Fax: 703-860-5303
Mailing address:
  • Phone: 703-860-1818
  • Fax: 703-860-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: