1306830047 NPI number — MANJIT KAUR RISAM M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306830047 NPI number — MANJIT KAUR RISAM M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RISAM

Provider First Name:

MANJIT

Provider Middle Name:

KAUR

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1306830047

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/29/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

8110 MAPLE LAWN BLVD STE 235

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FULTON

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20759-2694

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-340-8339

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

3060 MITCHELLVILLE RD

Provider Second Line Business Practice Location Address:

210

Provider Business Practice Location Address City Name:

BOWIE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20716-1389

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-249-4090

Provider Business Practice Location Address Fax Number:

301-390-1344

Provider Enumeration Date:

09/08/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  D0032735 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207VG0400X , with the licence number: D0032735 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 203249 . This is a "HEALTHKEEPERS ID#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 27866 . This is a "JOHN HOPKINS EHP ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 41985902 . This is a "CAREFIRST MD ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 56760001 . This is a "CAREFIRST DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: 46565 . This is a "MAMSI ID#" identifier . This identifiers is of the category "OTHER".
• Identifier: 495982 . This is a "NCPPO ID #" identifier . This identifiers is of the category "OTHER".
• Identifier: 04830 . This is a "AMERIGROUP ID#" identifier . This identifiers is of the category "OTHER".
• Identifier: 405671000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 4089037 . This is a "AETNA PROVIDER #" identifier . This identifiers is of the category "OTHER".
• Identifier: 0700031 . This is a "UNITEDHEALTHCARE ID #" identifier . This identifiers is of the category "OTHER".
• Identifier: 521854007 . This is a "ALL OTHER INS CO. ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".