Provider Demographics
NPI:1942618996
Name:VEDANTAM, LALITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:VEDANTAM
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 1:950 E SWAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5250
Mailing Address - Country:US
Mailing Address - Phone:301-292-7270
Mailing Address - Fax:301-203-0740
Practice Address - Street 1:950 E SWAN CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5250
Practice Address - Country:US
Practice Address - Phone:301-292-7270
Practice Address - Fax:301-203-0740
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD82595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD742503100Medicaid