1003977604 NPI number — DR. PRAFUL MARUTI RAMINENI M.D.

Table of content: DR. PRAFUL MARUTI RAMINENI M.D. (NPI 1003977604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003977604 NPI number — DR. PRAFUL MARUTI RAMINENI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMINENI
Provider First Name:
PRAFUL
Provider Middle Name:
MARUTI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003977604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6537 SOTHORON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22101-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-288-0285
Provider Business Mailing Address Fax Number:
202-785-1370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 M ST NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-785-4187
Provider Business Practice Location Address Fax Number:
202-785-1370
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD036474 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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