Individual
MADHAVI AMBATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.,
Contact information
Practice address
13900 BALTIMORE AVE, LAUREL, MD 20707-5009
(301) 725-5652
Mailing address
9837 SOLAR CRSE, LAUREL, MD 20723-6802
(609) 560-1441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0076685
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0076685
MARYLAND MD LICENSE
MD
Enumeration date
06/24/2010
Last updated
11/23/2021
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