Basic Information
| Provider Information | |||||||||
| NPI: | 1225471675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJU | ||||||||
| FirstName: | VIDYA | ||||||||
| MiddleName: | REDDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 TOWN CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036899037 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036899037 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2013 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101260010 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.