Provider Demographics
NPI:1992256135
Name:VIRGINIA INTEGRATIVE PSYCHIATRY, PC
Entity type:Organization
Organization Name:VIRGINIA INTEGRATIVE PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGARAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-479-1319
Mailing Address - Street 1:4900 HOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2651
Mailing Address - Country:US
Mailing Address - Phone:540-479-1319
Mailing Address - Fax:540-479-1326
Practice Address - Street 1:4900 HOOD DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2651
Practice Address - Country:US
Practice Address - Phone:540-479-1319
Practice Address - Fax:540-479-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022021112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty