Healthcare Provider Details

I. General information

NPI: 1184366429
Provider Name (Legal Business Name): LAVANYA MADABUSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9512 HARFORD RD STE 201
BALTIMORE MD
21234-3125
US

IV. Provider business mailing address

9512 HARFORD RD STE 201
BALTIMORE MD
21234-3125
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-0600
  • Fax:
Mailing address:
  • Phone: 410-882-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0104110
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: