Provider Demographics
NPI:1821201385
Name:TANDRA, NEERAJA (MD)
Entity Type:Individual
Prefix:
First Name:NEERAJA
Middle Name:
Last Name:TANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEERAJA
Other - Middle Name:
Other - Last Name:TALAKANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1897 PRESTON WHITE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5475
Mailing Address - Country:US
Mailing Address - Phone:703-468-1270
Mailing Address - Fax:
Practice Address - Street 1:1897 PRESTON WHITE DR STE 105
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5475
Practice Address - Country:US
Practice Address - Phone:703-468-1270
Practice Address - Fax:703-297-4917
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256086207RN0300X
MDD0074846207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821201385Medicaid
VAVVE093AMedicare PIN
VA1821201385Medicaid