Mahathi Nanduri, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401411896 Issued in VA

Practice address

12832 Williams Meadow CT
Herndon, VA 20171-4759

Phone

(571) 296-8047

NPI assigned

Jun 15, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mahathi Madiraju Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299110400000",
    "number": "1104053487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12832 WILLIAMS MEADOW CT",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201712957",
            "telephone_number": "571-296-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12832 WILLIAMS MEADOW CT",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201714759",
            "telephone_number": "571-296-8047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANDURI",
        "first_name": "MAHATHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2011-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411896",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55947",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAHATHI",
            "last_name": "MADIRAJU",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in Herndon, VA
• Providers in Herndon, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.