Healthcare Provider Details

I. General information

NPI: 1083775571
Provider Name (Legal Business Name): MAADHAVA ELLAURIE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21165 WHITFIELD PL SUITE 202
STERLING VA
20165-7280
US

IV. Provider business mailing address

21165 WHITFIELD PL SUITE 202
STERLING VA
20165-7280
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-0817
  • Fax: 703-444-0893
Mailing address:
  • Phone: 703-444-0817
  • Fax: 703-444-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAADHAVA ELLAURIE
Title or Position: OWNER
Credential: MD
Phone: 703-444-0817