Provider Demographics
NPI:1508160383
Name:MATTAY, VENKATA SATYANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SATYANAND
Last Name:MATTAY
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 1:1424 WOODHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2233
Mailing Address - Country:US
Mailing Address - Phone:703-597-3246
Mailing Address - Fax:703-748-3406
Practice Address - Street 1:1424 WOODHURST BLVD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2233
Practice Address - Country:US
Practice Address - Phone:703-597-3246
Practice Address - Fax:703-748-3406
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041706207U00000X, 2084N0400X
DCMD19915207U00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine