Provider Demographics
NPI:1124003249
Name:RAO-MAHADEVIA, JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:RAO-MAHADEVIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 BACK ACRE CIRCLE
Mailing Address - Street 2:SUITE 290C
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21711-7769
Mailing Address - Country:US
Mailing Address - Phone:301-703-5067
Mailing Address - Fax:301-703-5067
Practice Address - Street 1:2702 BACK ACRE CIRCLE
Practice Address - Street 2:SUITE 290C
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21711-7769
Practice Address - Country:US
Practice Address - Phone:301-703-5067
Practice Address - Fax:301-703-5067
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine