Basic Information
Provider Information | |||||||||
NPI: | 1821071028 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VELURI | ||||||||
FirstName: | SAVITHRI-CHANDANA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | VA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VELURI | ||||||||
OtherFirstName: | CHANDANA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 3700 FETTLER PARK | ||||||||
Address2: | DUMFRIES HEALTH CENTER | ||||||||
City: | DUMFRIES | ||||||||
State: | VA | ||||||||
PostalCode: | 22025 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7034417500 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3700 FETTLER PARK | ||||||||
Address2: | DUMFRIES HEALTH CENTER | ||||||||
City: | DUMFRIES | ||||||||
State: | VA | ||||||||
PostalCode: | 22025 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7034417500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/22/2005 | ||||||||
LastUpdateDate: | 04/03/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A78107 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | MD429390 | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 112325 | 01 | CA | BOARD CERT # | OTHER | MD429390 | 01 | PA | PA LICENSE | OTHER | 00A781070 | 01 | CA | BLUE SHIELD OF CA PIN | OTHER | BV7757238 | 01 | CA | DEA CERT | OTHER |