Provider Demographics
NPI:1922000181
Name:NAYAK, PRADEEP R (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:R
Last Name:NAYAK
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 1:2901 TELESTAR CT.
Mailing Address - Street 2:#300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:130 PARK ST SE
Practice Address - Street 2:STE 100
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4626
Practice Address - Country:US
Practice Address - Phone:703-281-1265
Practice Address - Fax:703-255-0571
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049006207RA0002X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060062643OtherRAILROAD MEDICARE VA#
MD112300900Medicaid
DC031739300Medicaid
VA1922000181Medicaid
DC060034779OtherRAILROAD MEDICARE DC #
DC031739300Medicaid
DC500603C42Medicare PIN
VA060000663Medicare PIN
VAF49796Medicare UPIN
DC031739300Medicaid
DC060034779OtherRAILROAD MEDICARE DC #