MEDICARE: THANUJA KATAKAM MD

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	390200000X	Student in an Organized Health Care Education/Training Program		MD

General Provider Information

NPI Number	:	1366233520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANUJA KATAKAM MD

Provider Business Mailing Address
First Line	:	901 HARRY S TRUMAN DR N
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774
Country	:	US
Telephone Number	:	240-677-0240
Fax Number	:	240-677-0021

Provider Business Practice Location Address
First Line	:	4000 GARDEN CITY DRIVE
Second Line	:	SUITE 810
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785
Country	:	US
Telephone Number	:	240-677-3100
Fax Number	:	301-851-5600

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	02/09/2026

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