Basic Information
| Provider Information | |||||||||
| NPI: | 1538131651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGABHIRAVA | ||||||||
| FirstName: | SOWJANYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574668683 | ||||||||
| FaxNumber: | 7574668892 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 VOLVO PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233201602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575494403 | ||||||||
| FaxNumber: | 7575494332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 01/03/2013 | ||||||||
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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 | 207RX0202X | 200500531 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 0101240337 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | BN7745005 | 01 | DEA | OTHER | 139V4 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 2237594 | 01 | UNITED HEALTHCARE | OTHER | 5900980 | 05 | NC | MEDICAID | 010326460 | 05 | VA | MEDICAID | 7889367 | 01 | AETNA | OTHER | P00408875 | 01 | MEDICARE RAILROAD | OTHER | 10013489 | 01 | OPTIMA | OTHER | 247277 | 01 | VA | ANTHEM BCBS | OTHER |