Provider Demographics
NPI:1982602777
Name:KOKA, NANDINI (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:
Last Name:KOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAPLE AVE W
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5727
Mailing Address - Country:US
Mailing Address - Phone:571-363-3539
Mailing Address - Fax:571-363-3540
Practice Address - Street 1:180 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5727
Practice Address - Country:US
Practice Address - Phone:571-363-3539
Practice Address - Fax:571-363-3540
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100503587Medicaid
VA100503587Medicaid