Healthcare Provider Details

I. General information

NPI: 1316030281
Provider Name (Legal Business Name): URSULA DENISE POYDRAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 GREENBELT RD SUITE 206
LANHAM MD
20706-2269
US

IV. Provider business mailing address

9821 GREENBELT RD SUITE 206
LANHAM MD
20706-2265
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-5862
  • Fax: 301-552-5864
Mailing address:
  • Phone: 301-552-5862
  • Fax: 301-552-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00D42448
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number00D42448
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD42448
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD42448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: