Provider Demographics
NPI:1619170685
Name:VIDYARTHI, JANAK A (MD)
Entity Type:Individual
Prefix:
First Name:JANAK
Middle Name:A
Last Name:VIDYARTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 ANNAPOLIS RD
Mailing Address - Street 2:STE 103
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1735
Mailing Address - Country:US
Mailing Address - Phone:410-672-2255
Mailing Address - Fax:
Practice Address - Street 1:1130 ANNAPOLIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1648
Practice Address - Country:US
Practice Address - Phone:410-672-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73586208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025815720001Medicaid
PA1025815720001Medicaid