Provider Demographics
NPI:1093949422
Name:SHIRSOLKAR, PRADNYA P (MD)
Entity Type:Individual
Prefix:
First Name:PRADNYA
Middle Name:P
Last Name:SHIRSOLKAR
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-368-3161
Mailing Address - Fax:
Practice Address - Street 1:25055 RIDING PLZ
Practice Address - Street 2:SUITE 220
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-5917
Practice Address - Country:US
Practice Address - Phone:703-722-5840
Practice Address - Fax:703-722-5821
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093949422Medicaid
VA1093949422Medicaid