Provider Demographics
NPI:1760681720
Name:UDDARAJU, MAITHRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAITHRY
Middle Name:
Last Name:UDDARAJU
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 1:1657 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1661
Mailing Address - Country:US
Mailing Address - Phone:973-294-5050
Mailing Address - Fax:
Practice Address - Street 1:1657 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1661
Practice Address - Country:US
Practice Address - Phone:419-794-2180
Practice Address - Fax:419-794-2175
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine