Provider Demographics
NPI:1831188119
Name:PENDYAL, KAUSALYA (MD)
Entity type:Individual
Prefix:DR
First Name:KAUSALYA
Middle Name:
Last Name:PENDYAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281814
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1814
Mailing Address - Country:US
Mailing Address - Phone:804-560-0490
Mailing Address - Fax:804-560-3424
Practice Address - Street 1:500 HIOAKS RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4061
Practice Address - Country:US
Practice Address - Phone:804-560-0490
Practice Address - Fax:804-560-3424
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831188119Medicaid
VA00X6027Q01Medicare PIN
VAMC10781Medicare PIN