Provider Demographics
NPI:1760567523
Name:RACHA, JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:RACHA
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 1:4100 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5506
Mailing Address - Country:US
Mailing Address - Phone:443-364-5500
Mailing Address - Fax:443-364-5501
Practice Address - Street 1:4100 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-5506
Practice Address - Country:US
Practice Address - Phone:443-364-5500
Practice Address - Fax:443-364-5501
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00629562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409207400Medicaid
MDH61275Medicare UPIN