Provider Demographics
NPI:1376600759
Name:MADIRAJU, KRISHNA PRASAD (MDFAAP)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRASAD
Last Name:MADIRAJU
Suffix:
Gender:M
Credentials:MDFAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22445 CONSERVANCY DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8068
Mailing Address - Country:US
Mailing Address - Phone:703-899-7593
Mailing Address - Fax:
Practice Address - Street 1:2024 OPITZ BLVD STE A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3388
Practice Address - Country:US
Practice Address - Phone:703-492-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010236568Medicaid
VA5686693OtherAETNA
VA897801OtherALLIANCE PPO
VA006720421Medicaid
VA006739491Medicaid
VA259327Medicaid
VA368437Medicaid
VA98446OtherAMERIGROUP