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General NPI Number Information
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NPI Number | 1972176832
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Entity Type | Individual
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Provider Name | PADMAVATHI MOGILI
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Gender | Female
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 11213 LEE HWY STE H
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City | FAIRFAX
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State | VA
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Zip | 22030-5698
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Country | US
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Telephone | 703-372-4449
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Fax |
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Provider Business Mailing Address
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Address Line | 11213 LEE HWY STE H
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City | FAIRFAX
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State | VA
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Zip | 22030-5698
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Country | US
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Telephone | 703-372-4449
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14774
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-008764
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C09071
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | PA14774
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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