Healthcare Provider Details

I. General information

NPI: 1376054676
Provider Name (Legal Business Name): SHRUTI RAMESH POOJARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7021 MARTIN LUTHER KING JR HWY
LANDOVER MD
20785-4016
US

IV. Provider business mailing address

PO BOX 419666
BOSTON MA
02241-9666
US

V. Phone/Fax

Practice location:
  • Phone: 301-341-4600
  • Fax:
Mailing address:
  • Phone: 410-970-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: