1649440322 NPI number — ANJANA PRASAD JINDAL M.D.

Table of content: ANJANA PRASAD JINDAL M.D. (NPI 1649440322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649440322 NPI number — ANJANA PRASAD JINDAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JINDAL
Provider First Name:
ANJANA
Provider Middle Name:
PRASAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRASAD
Provider Other First Name:
ANJANA
Provider Other Middle Name:
RAJENDRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649440322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1209 YORK RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-9490
Provider Business Mailing Address Fax Number:
410-821-9495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-821-9490
Provider Business Practice Location Address Fax Number:
410-821-9495
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD433708 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D72657 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 228038ZALL . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: D72657 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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