Healthcare Provider Details

I. General information

NPI: 1699612192
Provider Name (Legal Business Name): HENRY PODUTHASE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 REISTERSTOWN RD STE 105B
OWINGS MILLS MD
21117-4513
US

IV. Provider business mailing address

22421 SWEETSPIRE DR
CLARKSBURG MD
20871-8410
US

V. Phone/Fax

Practice location:
  • Phone: 410-989-9922
  • Fax:
Mailing address:
  • Phone: 806-324-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: