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General NPI Number Information
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NPI Number | 1174865125
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Entity Type | Individual
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Provider Name | SUDHI CHINTRISNA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2013
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Last Update Date | 03/17/2013
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Provider Practice Location Address
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Address Line | 1614 WILKENS AVE
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City | BALTIMORE
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State | MD
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Zip | 21223-3513
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Country | US
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Telephone | 410-624-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SPRING GREEN LN
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-1115
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Country | US
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Telephone | 410-785-3250
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | D17673
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License Number State | MD
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