Basic Information
| Provider Information | |||||||||
| NPI: | 1073767323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVATHI | ||||||||
| FirstName: | SUDHAKAR | ||||||||
| MiddleName: | VENKATA LAKSHMI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6934 AVIATION BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210612593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490825 | ||||||||
| Practice Location | |||||||||
| Address1: | 6934 AVIATION BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210612593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D72957 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | D72957 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | MD040391 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | Q1813 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.