=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538131651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOWJANYA NAGABHIRAVA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 744 BATTLEFIELD BLVD N STE 200
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-549-4403
-----------------------------------------------------
Fax | 757-549-4332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6350 CENTER DR STE 200
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-213-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 0101240337
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 200500531
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------