Healthcare Provider Details

I. General information

NPI: 1568497535
Provider Name (Legal Business Name): ANIL KANKARIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24035 THREE NOTCH RD
HOLLYWOOD MD
20636-4871
US

IV. Provider business mailing address

24035 THREE NOTCH RD
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-7500
  • Fax: 301-373-6500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0041616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: