Provider Demographics
NPI:1558333427
Name:KONA, PADMALATHA R (MD)
Entity Type:Individual
Prefix:
First Name:PADMALATHA
Middle Name:R
Last Name:KONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMALATHA
Other - Middle Name:R
Other - Last Name:MOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1201 SEVEN LOCKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2931
Mailing Address - Country:US
Mailing Address - Phone:301-652-5771
Mailing Address - Fax:301-652-6332
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-639-9510
Practice Address - Fax:703-639-9511
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101239087Medicaid
I34531Medicare UPIN
VA0101239087Medicaid