Healthcare Provider Details

I. General information

NPI: 1235427592
Provider Name (Legal Business Name): NEEHARIKA REPAKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 TOWN CENTER DR STE 306
RESTON VA
20190-3217
US

IV. Provider business mailing address

1830 TOWN CENTER DR STE 306
RESTON VA
20190-3217
US

V. Phone/Fax

Practice location:
  • Phone: 571-450-8300
  • Fax: 571-450-8301
Mailing address:
  • Phone: 571-450-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD83298
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101269601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: