Healthcare Provider Details

I. General information

NPI: 1962718221
Provider Name (Legal Business Name): MR. DHEERAJ K KATANGURI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

IV. Provider business mailing address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-9595
  • Fax: 410-398-8179
Mailing address:
  • Phone: 410-398-9595
  • Fax: 410-398-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18954
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004048
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: