Provider Demographics
NPI:1184821308
Name:ANANTH, MAMATHA SWETHADRI (MD,)
Entity Type:Individual
Prefix:DR
First Name:MAMATHA
Middle Name:SWETHADRI
Last Name:ANANTH
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 1:6304 MELLOW TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4911
Mailing Address - Country:US
Mailing Address - Phone:410-531-9514
Mailing Address - Fax:
Practice Address - Street 1:6304 MELLOW TWILIGHT CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4911
Practice Address - Country:US
Practice Address - Phone:410-531-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine