Provider Demographics
NPI:1174796445
Name:KAVITHA K NAKKA, MD INC.
Entity type:Organization
Organization Name:KAVITHA K NAKKA, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-435-1713
Mailing Address - Street 1:12601 WINTER WREN CT
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1830
Mailing Address - Country:US
Mailing Address - Phone:703-560-0404
Mailing Address - Fax:
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE # T-5
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-560-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06068936261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010051291Medicaid
DC4838OtherRAILROAD MEDICARE PIN
VA010051291Medicaid