Basic Information
| Provider Information | |||||||||
| NPI: | 1487692968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDURANGI | ||||||||
| FirstName: | ANANDA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 E MARSHALL ST | ||||||||
| Address2: | NORTH HOSPITAL ROOM 8053 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048284570 | ||||||||
| FaxNumber: | 8048284614 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 E MARSHALL ST | ||||||||
| Address2: | NORTH HOSPITAL ROOM 8053 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048284570 | ||||||||
| FaxNumber: | 8048284614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 36782 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 7104049 | 05 | VA | MEDICAID |