Healthcare Provider Details

I. General information

NPI: 1457430811
Provider Name (Legal Business Name): JUTHIKA BHAUMIK M.D.,M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST 210
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

821 N EUTAW ST 210
BALTIMORE MD
21201-4648
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-2250
  • Fax: 410-383-8378
Mailing address:
  • Phone: 410-383-2250
  • Fax: 410-383-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0018274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: