Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D72957 | MD |
Y | 111NI0900X | Internist | D72957 | MD |
N | 207R00000X | Internist | MD040391 | DC |
N | 111NI0900X | Internist | MD040391 | DC |
N | 207R00000X | Internist | Q1813 | TX |
N | 111NI0900X | Internist | Q1813 | TX |
N | 207RI0200X | Infectious Disease | D72957 | MD |
NPI | 1073767323 |
---|---|
Provider Name | Dr. Sudhakar Venkata Lakshmi Devathi |
First Address | Glen Burnie, MD 21061-2593 |
Second Address | Glen Burnie, MD 21061-2593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 14/08/2015 |