Healthcare Provider Details

I. General information

NPI: 1023571155
Provider Name (Legal Business Name): RAJU S ALLURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAJ ALLURI MD

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12359 SUNRISE VALLEY DR STE 260
RESTON VA
20191-3494
US

IV. Provider business mailing address

12359 SUNRISE VALLEY DR STE 260
RESTON VA
20191-3494
US

V. Phone/Fax

Practice location:
  • Phone: 571-267-7204
  • Fax:
Mailing address:
  • Phone: 571-267-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101275731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: