Provider Demographics
NPI:1750602389
Name:SRIKANTH MAHAVADI, DPM PC
Entity type:Organization
Organization Name:SRIKANTH MAHAVADI, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-966-8350
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-0357
Mailing Address - Country:US
Mailing Address - Phone:804-966-8350
Mailing Address - Fax:805-966-8999
Practice Address - Street 1:9050 POCAHONTAS TRAIL
Practice Address - Street 2:SUITE #F
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-0357
Practice Address - Country:US
Practice Address - Phone:804-966-8350
Practice Address - Fax:804-966-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009301429Medicaid
VA009301429Medicaid