Provider Demographics
NPI:1528002342
Name:NANDIPATI, S KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:KRISHNA
Last Name:NANDIPATI
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 1:3500 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3224
Mailing Address - Country:US
Mailing Address - Phone:301-843-2222
Mailing Address - Fax:301-843-2355
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-843-2222
Practice Address - Fax:301-843-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD381602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147647OtherBLUE CROSS
DCG939OtherBLUE CROSS
MD528031100Medicaid
MDKEW3NEOtherBLUE CROSS
MD528031100Medicaid
DCG939OtherBLUE CROSS
MDKEW3NEOtherBLUE CROSS