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General NPI Number Information
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NPI Number | 1295700615
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Entity Type | Individual
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Provider Name | ANURADHA TAKANTI M.D.,
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Gender | Female
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 7532 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 571-248-8380
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Fax | 571-261-1085
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Provider Business Mailing Address
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Address Line | 7532 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 571-248-8380
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Fax | 571-261-1085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101051891
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License Number State | VA
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