Provider Demographics
NPI:1013014463
Name:DEVADAS, INDIRA KARIYAPPA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:KARIYAPPA
Last Name:DEVADAS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9004 NAYGALL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-256-4254
Mailing Address - Fax:
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered