Provider Demographics
NPI:1538131651
Name:NAGABHIRAVA, SOWJANYA (MD)
Entity type:Individual
Prefix:
First Name:SOWJANYA
Middle Name:
Last Name:NAGABHIRAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4107
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:
Practice Address - Street 1:744 BATTLEFIELD BLVD N STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-549-4403
Practice Address - Fax:757-549-4332
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240337207RX0202X
NC200500531207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010326460Medicaid
2237594OtherUNITED HEALTHCARE
NC5900980Medicaid
7889367OtherAETNA
P00408875OtherMEDICARE RAILROAD
NC139V4OtherBLUE CROSS BLUE SHIELD
VA247277OtherANTHEM BCBS
VA247277OtherANTHEM BCBS
VA247277OtherANTHEM BCBS
NC5900980Medicaid
VA010326460Medicaid
VA011464D11Medicare PIN