Healthcare Provider Details

I. General information

NPI: 1184821480
Provider Name (Legal Business Name): SOUNDARYA NAGARAJA GOWDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7607 FOREST AVE STE 300
HENRICO VA
23229-4913
US

IV. Provider business mailing address

2530 GASKINS RD STE C
RICHMOND VA
23238-1483
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-2742
  • Fax: 804-288-9053
Mailing address:
  • Phone: 804-476-2390
  • Fax: 804-848-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD230539
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101248106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: