Healthcare Provider Details

I. General information

NPI: 1114973526
Provider Name (Legal Business Name): NITYA RAMACHANDRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 MEETING HOUSE RD SUITE 150
SANDY SPRING MD
20860-1038
US

IV. Provider business mailing address

17810 MEETING HOUSE RD STE 150
SANDY SPRING MD
20860-1047
US

V. Phone/Fax

Practice location:
  • Phone: 240-389-1722
  • Fax: 240-389-1746
Mailing address:
  • Phone: 240-389-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0054328
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: