MEDICARE: DR. APPAJI GONDI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	0101240011	VA
2	207K00000X	Allergy & Immunology Physician	MD036216	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174502132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APPAJI GONDI M.D.

Provider Business Mailing Address
First Line	:	1420 SPRING HILL RD
Second Line	:	STE 350
City	:	MC LEAN
State	:	VA
Zip	:	22102-3006
Country	:	US
Telephone Number	:	703-790-9722
Fax Number	:	703-893-8666

Provider Business Practice Location Address
First Line	:	1420 SPRING HILL RD
Second Line	:	STE 350
City	:	MC LEAN
State	:	VA
Zip	:	22102-3006
Country	:	US
Telephone Number	:	703-790-9722
Fax Number	:	703-893-8666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/28/2008

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