Provider Demographics
NPI:1346439148
Name:RAMALINGESWARA R. NIMMAGADDA
Entity Type:Organization
Organization Name:RAMALINGESWARA R. NIMMAGADDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMALINGESWARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIMMAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-629-3969
Mailing Address - Street 1:PO BOX 6111
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22040-6111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-356-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA769728Medicare PIN