Healthcare Provider Details

I. General information

NPI: 1790604106
Provider Name (Legal Business Name): ISHA PASSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N MAIN ST STE 101
BEL AIR MD
21014-8844
US

IV. Provider business mailing address

139 N MAIN ST STE 101
BEL AIR MD
21014-8844
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-9346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010533
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: