Provider Demographics
NPI:1427199389
Name:TADAVARTHY, JYOTHI P (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:P
Last Name:TADAVARTHY
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 1:1790 ELIZA WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1683
Mailing Address - Country:US
Mailing Address - Phone:717-728-2883
Mailing Address - Fax:
Practice Address - Street 1:33 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4432
Practice Address - Country:US
Practice Address - Phone:717-243-6033
Practice Address - Fax:717-243-0776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041087-E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019717680001Medicaid
PA173149QZTMedicare ID - Type Unspecified
PA173149JGZMedicare PIN