MEDICARE: MAADHAVA ELLAURIE MD PC

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	207KA0200X	Allergy Physician

General Provider Information

NPI Number	:	1801081989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAADHAVA ELLAURIE MD PC

Provider Business Mailing Address
First Line	:	46440 BENEDICT DR STE 212
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-6602
Country	:	US
Telephone Number	:	703-444-0817
Fax Number	:	703-444-0893

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD STE 103
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-775-5173
Fax Number	:	301-776-4213

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAADHAVA ELLAURIE
Credential	:	M.D.
Telephone Number	:	301-775-5173

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	06/20/2008

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