Provider Demographics
NPI:1780685784
Name:WARAVDEKAR, NEIL V (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:V
Last Name:WARAVDEKAR
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 1:7115 GUILFORD DRIVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704
Mailing Address - Country:US
Mailing Address - Phone:301-663-5922
Mailing Address - Fax:
Practice Address - Street 1:7115 GUILFORD DR
Practice Address - Street 2:SUITE #202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5199
Practice Address - Country:US
Practice Address - Phone:301-663-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047611207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366311600Medicaid
MD366311600Medicaid
MD239MMedicare ID - Type Unspecified