Provider Demographics
NPI:1649289562
Name:KAKANI, MALATHI L (PA-C)
Entity type:Individual
Prefix:
First Name:MALATHI
Middle Name:L
Last Name:KAKANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MALATHI
Other - Middle Name:L
Other - Last Name:PALLINANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 S MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5363
Mailing Address - Country:US
Mailing Address - Phone:301-829-9570
Mailing Address - Fax:301-829-1734
Practice Address - Street 1:1502 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5363
Practice Address - Country:US
Practice Address - Phone:301-829-9570
Practice Address - Fax:301-829-1734
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ71945Medicare UPIN
MD570LS739Medicare PIN