Provider Demographics
NPI:1003997339
Name:NUTANKALVA, LAVANYA (MD)
Entity Type:Individual
Prefix:
First Name:LAVANYA
Middle Name:
Last Name:NUTANKALVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 BROOKFIELD CORPORATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2122
Mailing Address - Country:US
Mailing Address - Phone:703-738-9989
Mailing Address - Fax:703-738-9991
Practice Address - Street 1:1860 TOWN CENTER DR STE 310
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5899
Practice Address - Country:US
Practice Address - Phone:703-738-9989
Practice Address - Fax:703-738-9991
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077934207RI0200X
DCMD034555207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010176531Medicaid
DC036829400Medicaid
MD408044100Medicaid
017582H13Medicare PIN
MD408044100Medicaid