Healthcare Provider Details

I. General information

NPI: 1063557510
Provider Name (Legal Business Name): PRIYADARSHINI SHARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRIYADARSHINI PRIYADARSHINI

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

105 WILLOW BEND DR APT 2B
OWINGS MILLS MD
21117-2676
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-4164
  • Fax:
Mailing address:
  • Phone: 443-857-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP20635
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: