Provider Demographics
NPI:1235750316
Name:SRI SAI RAJ,LLC
Entity Type:Organization
Organization Name:SRI SAI RAJ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PADMALATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARANIKOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:687-492-9804
Mailing Address - Street 1:PO BOX 31494
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-1494
Mailing Address - Country:US
Mailing Address - Phone:804-282-9133
Mailing Address - Fax:804-282-9135
Practice Address - Street 1:7600 AUTUMN PARK WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3868
Practice Address - Country:US
Practice Address - Phone:804-730-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101237077OtherVIRGINIA MEDICAL LICENSE