Provider Demographics
NPI:1801081989
Name:MAADHAVA ELLAURIE MD PC
Entity type:Organization
Organization Name:MAADHAVA ELLAURIE MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAADHAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLAURIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-775-5173
Mailing Address - Street 1:46440 BENEDICT DR STE 212
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-6602
Mailing Address - Country:US
Mailing Address - Phone:703-444-0817
Mailing Address - Fax:703-444-0893
Practice Address - Street 1:3450 FORT MEADE RD STE 103
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-775-5173
Practice Address - Fax:301-776-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty