Basic Information
| Provider Information | |||||||||
| NPI: | 1801184759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARELLA | ||||||||
| FirstName: | LAKSHMI | ||||||||
| MiddleName: | LAVANYA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6710 OXON HILL RD STE 200B | ||||||||
| Address2: | |||||||||
| City: | OXON HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207451124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013737900 | ||||||||
| FaxNumber: | 3013736900 | ||||||||
| Practice Location | |||||||||
| Address1: | 6710 OXON HILL RD STE 200B | ||||||||
| Address2: | |||||||||
| City: | OXON HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207451124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013737900 | ||||||||
| FaxNumber: | 3013736900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0078205 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 512411500 | 05 | MD | MEDICAID |