Provider Demographics
NPI:1396773859
Name:NIMMAGADDA, RAM
Entity type:Individual
Prefix:DR
First Name:RAM
Middle Name:
Last Name:NIMMAGADDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAM
Other - Middle Name:
Other - Last Name:NIMMAGADDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-356-5400
Mailing Address - Fax:703-356-0292
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-356-5400
Practice Address - Fax:703-356-0292
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046321207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76318Medicare UPIN
VA553681R28Medicare PIN