Provider Demographics
NPI:1104812700
Name:REKULAPELLI, PRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:REKULAPELLI
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 1:4229 LAFAYETTE CENTER DR
Mailing Address - Street 2:SUITE 1425
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1261
Mailing Address - Country:US
Mailing Address - Phone:703-263-9323
Mailing Address - Fax:703-263-0311
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1425
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-263-9323
Practice Address - Fax:703-263-0311
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-08-24
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
VA0101235112208000000X
MDD0059828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics