Provider Demographics
NPI:1295700615
Name:TAKANTI, ANURADHA (MD,)
Entity type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:
Last Name:TAKANTI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7532 GARDNER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3414
Mailing Address - Country:US
Mailing Address - Phone:571-248-8380
Mailing Address - Fax:571-261-1085
Practice Address - Street 1:7532 GARDNER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3414
Practice Address - Country:US
Practice Address - Phone:571-248-8380
Practice Address - Fax:571-261-1085
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010110297Medicaid