| Virginia Id Doctors Llc | |
|
1860 Town Center Dr Ste 310 Reston VA 20190-5899 | |
| (703) 738-9989 | |
| (703) 738-9991 |
| Full Name | Virginia Id Doctors Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1860 Town Center Dr Ste 310, Reston, Virginia |
| Authorized Official Name and Position | Lavanya Nutankalva (PRESIDENT) |
| Authorized Official Contact | 5714779909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virginia Id Doctors Llc 4437 Brookfield Corporate Dr Ste 101 Chantilly VA 20151-2122 Ph: (703) 738-9989 | Virginia Id Doctors Llc 1860 Town Center Dr Ste 310 Reston VA 20190-5899 Ph: (703) 738-9989 |
| NPI Number | 1952812364 |
|---|---|
| Provider Enumeration Date | 10/12/2017 |
| Last Update Date | 07/10/2023 |
| Medicare PECOS PAC ID | 8123387750 |
|---|---|
| Medicare Enrollment ID | O20180105000438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952812364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 0101240702 (Virginia) | Primary |
| Provider Name | Lavanya Nutankalva |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1003997339 PECOS PAC ID: 7012946734 Enrollment ID: I20050811000974 |
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