Provider Demographics
NPI:1669429312
Name:BIRUDAVOL, NAG RAJ (MD)
Entity type:Individual
Prefix:
First Name:NAG RAJ
Middle Name:
Last Name:BIRUDAVOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJ
Other - Middle Name:NAG
Other - Last Name:BIRUDAVOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3033 WILSON BLVD # E-565
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3866
Mailing Address - Country:US
Mailing Address - Phone:413-426-3718
Mailing Address - Fax:
Practice Address - Street 1:4600 SPOTSYLVANIA PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7762
Practice Address - Country:US
Practice Address - Phone:540-498-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49484207P00000X
TXR5365207P00000X
IN0107-4694A207P00000X
VA0101-034-785207P00000X
WV11997207P00000X
MDD00-75072207P00000X
OH35-048539207P00000X
KY58601207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine