=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083775571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAADHAVA ELLAURIE MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 10/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21165 WHITFIELD PL SUITE 202
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20165-7280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-444-0817
-----------------------------------------------------
Fax | 703-444-0893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21165 WHITFIELD PL SUITE 202
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20165-7280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-444-0817
-----------------------------------------------------
Fax | 703-444-0893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAADHAVA ELLAURIE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-444-0817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------