Provider Demographics
NPI:1487319273
Name:DATLA, RAJU
Entity type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:DATLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14920 OLD COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1610
Mailing Address - Country:US
Mailing Address - Phone:240-305-3484
Mailing Address - Fax:301-476-7544
Practice Address - Street 1:14920 OLD COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1610
Practice Address - Country:US
Practice Address - Phone:240-305-3484
Practice Address - Fax:301-476-7544
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other