Healthcare Provider Details

I. General information

NPI: 1265495733
Provider Name (Legal Business Name): MRS. VALSAMMA PUNNOOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH GREEN ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

750 ARDENWOOD DR
ELDERSBURG MD
21784-8130
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 410-552-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number106173
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: