Provider Demographics
NPI:1235182163
Name:KATIKINENI, MADHU MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:MOHAN
Last Name:KATIKINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MADHU
Other - Middle Name:K
Other - Last Name:MOHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6510 KENILWORTH AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:301-927-7750
Mailing Address - Fax:240-582-7411
Practice Address - Street 1:6510 KENILWORTH AVE STE 1200
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:301-927-7750
Practice Address - Fax:240-582-7411
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023125207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD772801800Medicaid
MD966L551EOtherMEDICARE PIN
DC417424R96Medicare PIN
MD772801800Medicaid
MD966L551EOtherMEDICARE PIN