Provider Demographics
NPI:1063568061
Name:RAMBHALA, LALITHA S (MD)
Entity type:Individual
Prefix:
First Name:LALITHA
Middle Name:S
Last Name:RAMBHALA
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 1:2 E GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2938
Mailing Address - Country:US
Mailing Address - Phone:703-535-5568
Mailing Address - Fax:703-535-1583
Practice Address - Street 1:2 E GLEBE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2938
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:703-535-1583
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045815207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE99339Medicare UPIN
VA004957P52Medicare ID - Type Unspecified