Healthcare Provider Details

I. General information

NPI: 1710121694
Provider Name (Legal Business Name): MAYA SUBBALAKSHMI VENKATARAMANI MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 E MONUMENT ST SUITE 2-300D
BALTIMORE MD
21287-0007
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 518-859-9718
  • Fax:
Mailing address:
  • Phone: 518-859-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0077322
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0077322
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: