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General NPI Number Information
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NPI Number | 1386079788
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Entity Type | Organization
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Legal Business Name | PRISMAMED SERVICES LLC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 44790 MAYNARD SQUARE SUITE 320
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 703-868-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 44790 MAYNARD SQUARE SUITE 320
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 703-868-3011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VANDANA PALAGIRI
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Credential | M.D
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Telephone | 703-868-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101250130
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License Number State | VA
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