Provider Demographics
NPI:1558319319
Name:NANDEDKAR, MAITHILY A (MD)
Entity type:Individual
Prefix:DR
First Name:MAITHILY
Middle Name:A
Last Name:NANDEDKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 ROBERT FULTON DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5461
Mailing Address - Country:US
Mailing Address - Phone:703-860-1818
Mailing Address - Fax:703-860-5303
Practice Address - Street 1:1801 ROBERT FULTON DR
Practice Address - Street 2:SUITE 520
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5461
Practice Address - Country:US
Practice Address - Phone:703-860-1818
Practice Address - Fax:703-860-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7985486OtherAETNA
VA192618OtherANTHEM BCBS
MD4036-0001OtherCAREFIRST BCBS
MD4036-0001OtherCAREFIRST BCBS