Provider Demographics
NPI:1104393685
Name:LAKSHMI P. BADDELA, MD, PC
Entity Type:Organization
Organization Name:LAKSHMI P. BADDELA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-371-6999
Mailing Address - Street 1:4 NORTH AVE STE 303B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2314
Mailing Address - Country:US
Mailing Address - Phone:443-371-6999
Mailing Address - Fax:443-371-6998
Practice Address - Street 1:4 NORTH AVE STE 303B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2314
Practice Address - Country:US
Practice Address - Phone:443-371-6999
Practice Address - Fax:443-371-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2121000-00Medicaid