Provider Demographics
NPI:1548437106
Name:GAJJALA, JHANSI LAKSHMI
Entity type:Individual
Prefix:
First Name:JHANSI
Middle Name:LAKSHMI
Last Name:GAJJALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 OLD STONE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5958
Mailing Address - Country:US
Mailing Address - Phone:301-879-6939
Mailing Address - Fax:
Practice Address - Street 1:2139 GEORGIA NWAVE 3RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3035
Practice Address - Country:US
Practice Address - Phone:202-865-7513
Practice Address - Fax:202-865-1037
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036368207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease