Organization
VIRGINIA ID DOCTORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAVANYA NUTANKALVA MD (PRESIDENT)
(571) 477-9909
Entity
Organization
Contact information
Practice address
1860 TOWN CENTER DR STE 310, RESTON, VA 20190-5899
(703) 738-9989
(703) 738-9991
Mailing address
4437 BROOKFIELD CORPORATE DR STE 101, CHANTILLY, VA 20151-2122
(703) 738-9989
(703) 738-9991
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
0101240702
VA
Other
Enumeration date
10/12/2017
Last updated
07/10/2023
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