Provider Demographics
NPI:1891721502
Name:MATTAY, NEERAJA CHARAGUNDLA (MD)
Entity Type:Individual
Prefix:
First Name:NEERAJA
Middle Name:CHARAGUNDLA
Last Name:MATTAY
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 1:1424 WOODHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2233
Mailing Address - Country:US
Mailing Address - Phone:703-748-4613
Mailing Address - Fax:
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:301
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-222-2773
Practice Address - Fax:703-222-6093
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00305Medicare PIN
VAF32029Medicare UPIN
VA000M97D05Medicare ID - Type Unspecified