=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376054676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHRUTI RAMESH POOJARY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2017
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7021 MARTIN LUTHER KING JR HWY
-----------------------------------------------------
City | LANDOVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-4016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-341-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 419666
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02241-9666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-970-8190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 042292
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------