Provider Demographics
NPI:1013955640
Name:NANDIPATI, SAILAJA
Entity type:Individual
Prefix:DR
First Name:SAILAJA
Middle Name:
Last Name:NANDIPATI
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 1:10 SAINT PATRICKS DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4527
Mailing Address - Country:US
Mailing Address - Phone:301-373-7900
Mailing Address - Fax:301-373-6900
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-843-2223
Practice Address - Fax:301-843-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038037207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG938OtherBLUE CROSS
MDKEW2AROtherBLUE CROSS
MDP00073690OtherRAILROAD MEDICARE
MD391192600Medicaid
VA466904OtherBLUE CROSS
DCG938OtherBLUE CROSS
MDB59928Medicare UPIN