Healthcare Provider Details

I. General information

NPI: 1689686693
Provider Name (Legal Business Name): TRUMAN F SOUDAH,MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 WALTHAM WOODS RD.
BALTIMORE MD
21234
US

IV. Provider business mailing address

8813 WALTHAM WOODS RD.
BALTIMORE MD
21234
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-8690
  • Fax: 410-661-4416
Mailing address:
  • Phone: 410-661-8690
  • Fax: 410-661-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0018966
License Number StateMD

VIII. Authorized Official

Name: DR. TRUMAN FARAH SOUDAH
Title or Position: OWNER
Credential: OB,GYN
Phone: 410-661-8690