Healthcare Provider Details

I. General information

NPI: 1437706991
Provider Name (Legal Business Name): POOJA RAJENDRA DESHPANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 MARYLAND AVE STE 200
BALTIMORE MD
21201-5804
US

IV. Provider business mailing address

1734 MARYLAND AVE STE 200
BALTIMORE MD
21201-5804
US

V. Phone/Fax

Practice location:
  • Phone: 877-674-2843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: