Provider Demographics
NPI:1770902801
Name:RAJAMOORTHI, SADHANA
Entity type:Individual
Prefix:
First Name:SADHANA
Middle Name:
Last Name:RAJAMOORTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAPLE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4243
Mailing Address - Country:US
Mailing Address - Phone:301-699-7700
Mailing Address - Fax:301-779-9001
Practice Address - Street 1:4151 BLADENSBURG RD
Practice Address - Street 2:
Practice Address - City:COLMAR MANOR
Practice Address - State:MD
Practice Address - Zip Code:20722-1928
Practice Address - Country:US
Practice Address - Phone:301-699-7707
Practice Address - Fax:301-779-9001
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101262124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program