Provider Demographics
NPI:1184129975
Name:LANKAPALLI, SWETCHA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SWETCHA
Middle Name:
Last Name:LANKAPALLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ISHAM RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4332
Mailing Address - Country:US
Mailing Address - Phone:703-399-5616
Mailing Address - Fax:
Practice Address - Street 1:45 THOMAS JOHNSON DR STE 209
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4490
Practice Address - Country:US
Practice Address - Phone:301-665-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006756363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty