Healthcare Provider Details

I. General information

NPI: 1316362288
Provider Name (Legal Business Name): LORI ANN MADHOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SAINT PAUL ST SUITE 1660
BALTIMORE MD
21202-1626
US

IV. Provider business mailing address

PO BOX 1687
ROCKVILLE MD
20849-1687
US

V. Phone/Fax

Practice location:
  • Phone: 301-649-7170
  • Fax: 301-260-8487
Mailing address:
  • Phone: 301-649-7170
  • Fax: 301-260-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: