Provider Demographics
NPI:1942275714
Name:ELLAURIE, MAADHAVA (MD)
Entity Type:Individual
Prefix:
First Name:MAADHAVA
Middle Name:
Last Name:ELLAURIE
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 1:21165 WHITFIELD PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7280
Mailing Address - Country:US
Mailing Address - Phone:703-444-0817
Mailing Address - Fax:703-444-0893
Practice Address - Street 1:21165 WHITFIELD PL
Practice Address - Street 2:SUITE 202
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7280
Practice Address - Country:US
Practice Address - Phone:703-444-0817
Practice Address - Fax:703-444-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057402207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87274Medicare UPIN