MEDICARE: DR. REKHA NUGARAM 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101236869	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06695	OTHER	VA	GROUP PTAN
2	C09633	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1912962085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REKHA NUGARAM M.D.,

Provider Business Mailing Address
First Line	:	3660 BOULEVARD
Second Line	:	SUITE G
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1345
Country	:	US
Telephone Number	:	804-526-5566
Fax Number	:	804-526-5568

Provider Business Practice Location Address
First Line	:	3660 BOULEVARD
Second Line	:	SUITE G
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1345
Country	:	US
Telephone Number	:	804-526-5566
Fax Number	:	804-526-5568

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	02/22/2012

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