Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 0101041706 | VA |
N | 207U00000X | Nuclear Medicine Specialist | MD19915 | DC |
Y | 2084N0400X | Neurologist | 0101041706 | VA |
N | 2084N0400X | Neurologist | MD19915 | DC |
NPI | 1508160383 |
---|---|
Provider Name | Dr. Venkata Satyanand Mattay |
First Address | Mc Lean, VA 22102-2233 |
Second Address | Mc Lean, VA 22102-2233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 07/01/2011 |