Provider Demographics
NPI:1538131651
Name:NAGABHIRAVA, SOWJANYA (MD)
Entity Type:Individual
Prefix:
First Name:SOWJANYA
Middle Name:
Last Name:NAGABHIRAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 LAKE WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1871
Mailing Address - Country:US
Mailing Address - Phone:757-466-8683
Mailing Address - Fax:757-466-8892
Practice Address - Street 1:725 VOLVO PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1602
Practice Address - Country:US
Practice Address - Phone:757-549-4403
Practice Address - Fax:757-549-4332
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500531207RX0202X
VA0101240337207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139V4OtherBLUE CROSS BLUE SHIELD
2237594OtherUNITED HEALTHCARE
NC5900980Medicaid
VA010326460Medicaid
7889367OtherAETNA
P00408875OtherMEDICARE RAILROAD
10013489OtherOPTIMA
VA247277OtherANTHEM BCBS
VA247277OtherANTHEM BCBS
NC5900980Medicaid
VA010326460Medicaid
VA011464D11Medicare PIN