Provider Demographics
NPI:1982812210
Name:PRASAD REKULAPELLI MD PC
Entity Type:Organization
Organization Name:PRASAD REKULAPELLI MD PC
Other - Org Name:DULLES PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REKULAPELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-263-9323
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR
Mailing Address - Street 2:SUITE 1425
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1209
Mailing Address - Country:US
Mailing Address - Phone:703-263-9323
Mailing Address - Fax:703-263-0311
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1425
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1209
Practice Address - Country:US
Practice Address - Phone:703-263-9323
Practice Address - Fax:703-263-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0637964-8261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care