Provider Demographics
NPI:1255722005
Name:WILLOW PSYCHIATRY LIMITED
Entity type:Organization
Organization Name:WILLOW PSYCHIATRY LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:GAYATRI
Authorized Official - Last Name:AGEPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-620-5151
Mailing Address - Street 1:41912 CLOVER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-1765
Mailing Address - Country:US
Mailing Address - Phone:571-620-5151
Mailing Address - Fax:571-421-1963
Practice Address - Street 1:20925 PROFESSIONAL PLZ
Practice Address - Street 2:310
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:571-620-5151
Practice Address - Fax:571-421-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012546262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty