Provider Demographics
NPI:1033121058
Name:PRAYAGA, RAMA (MD)
Entity type:Individual
Prefix:DR
First Name:RAMA
Middle Name:
Last Name:PRAYAGA
Suffix:
Gender:M
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:PO BOX 11139
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-9139
Mailing Address - Country:US
Mailing Address - Phone:301-674-2742
Mailing Address - Fax:
Practice Address - Street 1:5194 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1402
Practice Address - Country:US
Practice Address - Phone:703-820-1900
Practice Address - Fax:866-528-6229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD519062084P0800X, 2084P0802X, 2084P0805X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG57867Medicare UPIN