Healthcare Provider Details

I. General information

NPI: 1104881200
Provider Name (Legal Business Name): ATCHUTHANAND BUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 OPAL COURT
HAGERSTOWN MD
21740
US

IV. Provider business mailing address

1141 OPAL COURT
HAGERSTOWN MD
21740
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-6666
  • Fax: 301-791-4549
Mailing address:
  • Phone: 301-791-6666
  • Fax: 301-791-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0053290
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0053290
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0053290
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier552300100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: