Individual
VENKATA LAAVANYA DIVAKARUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10085 RED RUN BLVD STE 105, OWINGS MILLS, MD 21117-4811
(410) 581-7804
Mailing address
10085 RED RUN BLVD STE 105, OWINGS MILLS, MD 21117-4811
(410) 581-7804
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D98286
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221376100
—
MD
Enumeration date
04/02/2020
Last updated
07/05/2024
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