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Organization

SRIKANTH MAHAVADI

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SRIKANTH MAHAVADI (OWNER)
(804) 829-8999
Entity
Organization

Contact information

Practice address
9050 POCAHONTAS TRAIL, SUITE F, PROVIDENCE FORGE, VA 23140
(804) 966-8350
Mailing address
PO BOX 357, PROVIDENCE FORGE, VA 23140-0357

Taxonomy

Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009201429
VA
Enumeration date
08/05/2009
Last updated
01/27/2010
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