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NPI Code Detail

MEDICARE: SRI LAKSHMI VIDHYADHARI BANDARU PT

MEDICARE: SRI LAKSHMI VIDHYADHARI BANDARU PT
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
1208100000XPhysical Medicine & Rehabilitation Physician30719MD

General Provider Information

NPI Number : 1902760085
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRI LAKSHMI VIDHYADHARI BANDARU PT
Provider Business Mailing Address
First Line : 9314 CHERRY HILL RD APT 424
Second Line :
City : COLLEGE PARK
State : MD
Zip : 20740-1250
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7021 MARTIN LUTHER KING JR HWY
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-4016
Country : US
Telephone Number : 301-341-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2025
Last Update Date : 12/12/2025

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