Healthcare Provider Details

I. General information

NPI: 1932216330
Provider Name (Legal Business Name): PRAKASH D. ADAWADKAR, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 DALE BLVD
WOODBRIDGE VA
22193-2243
US

IV. Provider business mailing address

4201 DALE BLVD
WOODBRIDGE VA
22193-2243
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-0300
  • Fax: 703-670-6759
Mailing address:
  • Phone: 703-670-0300
  • Fax: 703-670-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAKASH D. ADAWADKAR
Title or Position: OWNER
Credential: M.D.
Phone: 703-670-0300