Individual
MRS. DIVIYALAXMI MURUGANANDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
381 ELDEN ST STE 1000, HERNDON, VA 20170-4842
(703) 481-1505
(703) 742-8793
Mailing address
1521 BOYD POINTE WAY APT 2710, TYSONS, VA 22182-7561
(703) 981-5533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0110006077
VA
363AM0700X
Medical Physician Assistant
Primary
0110006077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110006077
LICENSE
VA
Enumeration date
02/02/2018
Last updated
11/27/2023
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