Provider Demographics
NPI:1477584910
Name:VELUGUBANTI, PRASADARAO S (MD)
Entity Type:Individual
Prefix:
First Name:PRASADARAO
Middle Name:S
Last Name:VELUGUBANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 LEESBURG PIKE STE 630
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2641
Mailing Address - Country:US
Mailing Address - Phone:703-861-9404
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:8230 LEESBURG PIKE STE 630
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2641
Practice Address - Country:US
Practice Address - Phone:703-861-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033701207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology