Healthcare Provider Details

I. General information

NPI: 1306694153
Provider Name (Legal Business Name): RITU BHAMBHANI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MARTIN LUTHER KING JR BLVD STE 102
BALTIMORE MD
21201-1221
US

IV. Provider business mailing address

100 WALTER WARD BLVD STE 300
ABINGDON MD
21009-1286
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-8971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RITU T BHAMBHANI
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 410-777-8971