Provider Demographics
NPI:1235395583
Name:POTRU, RACHANA (MD)
Entity Type:Individual
Prefix:
First Name:RACHANA
Middle Name:
Last Name:POTRU
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 1:3299 WOODBURN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-7318
Mailing Address - Country:US
Mailing Address - Phone:703-522-7476
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD STE 220
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7318
Practice Address - Country:US
Practice Address - Phone:703-522-7476
Practice Address - Fax:703-204-1968
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAP3881528-72219207R00000X
VA0101253503207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine