Provider Demographics
NPI:1801209036
Name:GADIRAJU, GEETHA
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:GADIRAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SEETARAMPURAM ST
Mailing Address - Street 2:
Mailing Address - City:BHIMVARAM
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:50171
Mailing Address - Country:IN
Mailing Address - Phone:0881-622-3625
Mailing Address - Fax:
Practice Address - Street 1:448 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3619
Practice Address - Country:US
Practice Address - Phone:703-777-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207739183500000X
MD17992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist