Provider Demographics
NPI:1306089172
Name:THAMBISETTY, MADHAV
Entity type:Individual
Prefix:DR
First Name:MADHAV
Middle Name:
Last Name:THAMBISETTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BAYVIEW BLVD
Mailing Address - Street 2:BRC 4B-311
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 BAYVIEW BLVD
Practice Address - Street 2:BRC 4B-311
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2816
Practice Address - Country:US
Practice Address - Phone:410-558-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00684232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology