Provider Demographics
NPI:1487609780
Name:MENON, AERATH SRIKUMAR (MD)
Entity type:Individual
Prefix:
First Name:AERATH
Middle Name:SRIKUMAR
Last Name:MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AROTH
Other - Middle Name:SRIKUMAR
Other - Last Name:MENON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-832-2729
Mailing Address - Fax:
Practice Address - Street 1:901 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 129
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2600
Practice Address - Country:US
Practice Address - Phone:410-832-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00424112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry