Provider Demographics
NPI:1114231545
Name:JASTI, MADHU SREEKANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU SREEKANTH
Middle Name:
Last Name:JASTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2917
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:
Practice Address - Street 1:203 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6905
Practice Address - Country:US
Practice Address - Phone:410-553-8160
Practice Address - Fax:410-553-8159
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4544332084N0400X
MDD827002084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology