Provider Demographics
NPI:1134268618
Name:KATTA, LAURA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RAO
Last Name:KATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:RAO KATTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 N BROADWAY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2020
Mailing Address - Country:US
Mailing Address - Phone:410-732-8229
Mailing Address - Fax:410-732-8477
Practice Address - Street 1:550 N BROADWAY
Practice Address - Street 2:SUITE 214
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2020
Practice Address - Country:US
Practice Address - Phone:410-732-8229
Practice Address - Fax:410-732-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014234207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4737LSOtherBLUE CROSS BLUE SHIELD MD
MD977931100Medicaid
MD977931100Medicaid
MDD76513Medicare UPIN