MEDICARE: DR. MADHAVI KAKARLA 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
1	2084P0800X	Psychiatry Physician	0101251023	VA

General Provider Information

NPI Number	:	1063776599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADHAVI KAKARLA M.D

Provider Business Mailing Address
First Line	:	13005 BALD HORNET TRCE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4681
Country	:	US
Telephone Number	:	301-262-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	13005 BALD HORNET TRCE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4681
Country	:	US
Telephone Number	:	301-262-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	06/29/2012

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