Individual
DR. KRISHNA PRASAD MADIRAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.FAAP
Contact information
Practice address
2024 OPITZ BLVD STE A, WOODBRIDGE, VA 22191-3388
(703) 492-7000
Mailing address
22445 CONSERVANCY DR, ASHBURN, VA 20148-8068
(703) 899-7593
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101054958
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006720421
—
VA
05
—
006739491
—
VA
05
—
010236568
—
VA
05
—
259327
—
VA
05
—
368437
—
VA
01
—
5686693
AETNA
VA
01
—
897801
ALLIANCE PPO
VA
01
—
98446
AMERIGROUP
VA
Enumeration date
01/03/2007
Last updated
11/07/2012
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