Healthcare Provider Details

I. General information

NPI: 1942325477
Provider Name (Legal Business Name): NEETHU KOSHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

701 W PRATT ST PSYCHIATRY, 4TH FLOOR
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3522
  • Fax: 410-328-8479
Mailing address:
  • Phone: 410-328-3522
  • Fax: 410-328-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD62858
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: