Basic Information
| Provider Information | |||||||||
| NPI: | 1427163914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEREDDI | ||||||||
| FirstName: | KAVITHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1504 SUMMERCHASE CT | ||||||||
| Address2: | UNIT B | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201941155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037386760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5755 CEDAR LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107407890 | ||||||||
| FaxNumber: | 4108844643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D63650 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101236559 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.