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NPI Code Detail

MEDICARE: DR. JYOTHI RACHA M.D.

MEDICARE: DR. JYOTHI RACHA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianD0062956MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760567523
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTHI RACHA M.D.
Provider Business Mailing Address
First Line : 4100 COLLEGE AVE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-5506
Country : US
Telephone Number : 443-364-5500
Fax Number : 443-364-5501
Provider Business Practice Location Address
First Line : 4100 COLLEGE AVE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-5506
Country : US
Telephone Number : 443-364-5500
Fax Number : 443-364-5501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 02/03/2014

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