Healthcare Provider Details

I. General information

NPI: 1962800805
Provider Name (Legal Business Name): SUMATI HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROFESSIONAL DR
GAITHERSBURG MD
20879
US

IV. Provider business mailing address

610 PROFESSIONAL DR
GAITHERSBURG MD
20879
US

V. Phone/Fax

Practice location:
  • Phone: 240-683-6202
  • Fax: 240-683-6203
Mailing address:
  • Phone: 240-683-6202
  • Fax: 240-683-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: