Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 6550 | NE |
Y | 207QA0505X | Family Doctor - Adult Medicine | D77284 | MD |
NPI | 1255610580 |
---|---|
Provider Name | Anupama Shankar Khandare |
First Address | Cumberland, MD 21502-4331 |
Second Address | Cumberland, MD 21502-4331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2011 |
Last Update Date | 04/10/2016 |