Provider Demographics
NPI:1992095079
Name:PRINCE WILLIAM HOSPITAL
Entity type:Organization
Organization Name:PRINCE WILLIAM HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, NEONATOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:SHANTHARAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-369-8134
Mailing Address - Street 1:8700 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4418
Mailing Address - Country:US
Mailing Address - Phone:703-369-8134
Mailing Address - Fax:
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:703-369-8134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty