Healthcare Provider Details

I. General information

NPI: 1528144979
Provider Name (Legal Business Name): M & S KULATHUNGAM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 BELAIR ROAD
BALTIMORE MD
21236
US

IV. Provider business mailing address

8020 BELAIR ROAD
BALTIMORE MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 410-668-3000
  • Fax:
Mailing address:
  • Phone: 410-668-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD15634
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0020188
License Number StateMD

VIII. Authorized Official

Name: MRS. MANORANJITHAM KULATHUNGAM
Title or Position: VICE PRESIDENT & SECRETARY
Credential: MD
Phone: 410-668-3000