Healthcare Provider Details

I. General information

NPI: 1851688931
Provider Name (Legal Business Name): KIRANMAYI ADIMOOLAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 MOUNTAIN RD
PASADENA MD
21122-2025
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8273
  • Fax:
Mailing address:
  • Phone: 443-462-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10040145
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD87962
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: