Provider Demographics
NPI:1619103983
Name:PAIDISETTY, SANJAY K (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:K
Last Name:PAIDISETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2602 BUFORD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3422
Mailing Address - Country:US
Mailing Address - Phone:804-272-8806
Mailing Address - Fax:804-272-2909
Practice Address - Street 1:2602 BUFORD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3422
Practice Address - Country:US
Practice Address - Phone:804-272-8806
Practice Address - Fax:804-272-2909
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012618172085R0202X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology