1962620658 NPI number — ANUSHA SIRITHARA

Table of content: (NPI 1962620658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962620658 NPI number — ANUSHA SIRITHARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANUSHA SIRITHARA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1962620658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 GATEWAY DR STE 2122B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-877-2585
Provider Business Mailing Address Fax Number:
410-877-2587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 GATEWAY DR STE 2122B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-877-2585
Provider Business Practice Location Address Fax Number:
410-877-2587
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIRITHARA
Authorized Official First Name:
ANUSHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-337-6700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D26191 , 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: 1962620658 . This is a "CORE SOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "EMBLEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: -196262020658 . This is a "AMERIGROUP - AMERICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "JOHN HOPKINS HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "RIVER SIDE HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "GOLDEN RULE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "MAIL HANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962620658 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "CHAMPUS TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "GEHA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1962620658 . This is a "HUMANA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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