Provider Demographics
NPI:1831207570
Name:DHANYAMRAJU, NAGENDRANATH (MD)
Entity type:Individual
Prefix:
First Name:NAGENDRANATH
Middle Name:
Last Name:DHANYAMRAJU
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 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:1300 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1628
Practice Address - Country:US
Practice Address - Phone:518-268-5554
Practice Address - Fax:518-268-5396
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204569207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05010OtherMVP
NY5399982OtherGHI
NY000490204001OtherBSNENY
NY7459616OtherAETNA
NY01749504Medicaid
NY10023510OtherCDPHP
NY204569-8ANOtherWC
NY66A641OtherEMPIRE BS
NY10023510OtherCDPHP
NYBB0615Medicare ID - Type Unspecified
NY7459616OtherAETNA