Provider Demographics
NPI:1598100125
Name:KAMATH, VIDYULATA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIDYULATA
Middle Name:
Last Name:KAMATH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VIDYA
Other - Middle Name:
Other - Last Name:KAMATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:MEYER 218
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-7218
Mailing Address - Country:US
Mailing Address - Phone:410-955-3268
Mailing Address - Fax:410-955-0504
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MEYER 218
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-7218
Practice Address - Country:US
Practice Address - Phone:410-955-3268
Practice Address - Fax:410-955-0504
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
MD05229103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist