Healthcare Provider Details

I. General information

NPI: 1851442008
Provider Name (Legal Business Name): JAYASREE PATLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 W. PERIMETER ROAD
ANDREWS AFB MD
20762
US

IV. Provider business mailing address

1580 SPRING GATE DR UNIT 4114
MC LEAN VA
22102-3444
US

V. Phone/Fax

Practice location:
  • Phone: 240-612-3781
  • Fax:
Mailing address:
  • Phone: 703-217-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101230586
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101230586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: