=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780668830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJENDRA SANIKOP M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2005
-----------------------------------------------------
Last Update Date | 02/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7702 DUNMANWAY
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21222-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-282-1792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 MEADOW RIDGE CT
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-420-8427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | D0041077
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------