Provider Demographics
NPI:1306054325
Name:NAGARAJA, SUDHIR (DO)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:
Last Name:NAGARAJA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3254
Mailing Address - Country:US
Mailing Address - Phone:540-479-1319
Mailing Address - Fax:540-479-1326
Practice Address - Street 1:1312 PROVIDENCE RIDGE TURN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-2187
Practice Address - Country:US
Practice Address - Phone:804-658-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022021112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry