Provider Demographics
NPI:1790916039
Name:GHADGE, PRIYA DNYANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:DNYANESH
Last Name:GHADGE
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 1:14143 LOTUS LN APT 1434
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6388
Mailing Address - Country:US
Mailing Address - Phone:813-928-1682
Mailing Address - Fax:
Practice Address - Street 1:13168 CENTERPOINTE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5287
Practice Address - Country:US
Practice Address - Phone:703-730-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine