Basic Information
Provider Information
NPI: 1972749232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMANATHAN
FirstName: METTE-JAYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: C.N.M, FNP
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 900 ELKRIDGE LANDING RD FL 2
Address2:  
City: LINTHICUM
State: MD
PostalCode: 210902924
CountryCode: US
TelephoneNumber: 4434625010
FaxNumber:  
Practice Location
Address1: 7601 OSLER DR
Address2:  
City: TOWSON
State: MD
PostalCode: 212047700
CountryCode: US
TelephoneNumber: 4103371150
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/16/2008
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XR159854MDY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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