Healthcare Provider Details

I. General information

NPI: 1811384886
Provider Name (Legal Business Name): ANUSHA KANAGALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226
US

IV. Provider business mailing address

5801 BREMO RD
RICHMOND VA
23226-1907
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7270
  • Fax:
Mailing address:
  • Phone: 804-287-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101264303
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: