Provider Demographics
NPI:1558307348
Name:MURTHY, REVATHY (MD)
Entity Type:Individual
Prefix:
First Name:REVATHY
Middle Name:
Last Name:MURTHY
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 1:6130 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1022
Mailing Address - Country:US
Mailing Address - Phone:301-322-7737
Mailing Address - Fax:301-386-2794
Practice Address - Street 1:6130 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1022
Practice Address - Country:US
Practice Address - Phone:301-322-7737
Practice Address - Fax:301-386-2794
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16273207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD772041600Medicaid
MDC88305Medicare UPIN
DC176570Medicare PIN