Healthcare Provider Details

I. General information

NPI: 1114908357
Provider Name (Legal Business Name): PRATIBHA JOSHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1217 BURTON ST
SILVER SPRING MD
20910-2707
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-855-3475
Mailing address:
  • Phone: 301-565-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD20005
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: