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General NPI Number Information
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NPI Number | 1104531342
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Entity Type | Individual
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Provider Name | PRAGYASHREE SHARMA BASYAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 1235 E MONUMENT ST
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City | BALTIMORE
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State | MD
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Zip | 21202-5327
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Country | US
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Telephone | 443-303-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 4421 GLENMORE AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-2010
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Country | US
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Telephone | 443-303-7076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | C0008766
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0008766
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License Number State | MD
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