Healthcare Provider Details

I. General information

NPI: 1922043561
Provider Name (Legal Business Name): SANJEEVANI TAKEMALKER KULKARNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 EDGEWOOD RD
EDGEWOOD MD
21040
US

IV. Provider business mailing address

PO BOX 856 1020 EDGEWOOD RD
EDGEWOOD MD
21040-0856
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-5755
  • Fax: 410-679-6613
Mailing address:
  • Phone: 410-679-5755
  • Fax: 410-679-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO27265
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: