MEDICARE: PAVAN NATARAJ MD

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	036160076	IL
2	207KA0200X	Allergy Physician	MD210001682	DC
3	207R00000X	Internal Medicine Physician	MT215920	PA

General Provider Information

NPI Number	:	1508359035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVAN NATARAJ MD

Provider Business Mailing Address
First Line	:	112 THOMAS JOHNSON DR STE 210
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4970
Country	:	US
Telephone Number	:	240-817-0810
Fax Number	:	240-817-0812

Provider Business Practice Location Address
First Line	:	4660 KENMORE AVE STE 516
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1313
Country	:	US
Telephone Number	:	703-997-0811
Fax Number	:	703-997-0820

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

Provider Enumeration Date	:	06/09/2018
Last Update Date	:	04/08/2026

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