Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | D58852 | MD |
NPI | 1023089471 |
---|---|
Provider Name | Anuradha Boddeti |
First Address | Baltimore, MD 21227-2542 |
Second Address | Glen Burnie, MD 21061-4983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 15/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
453700900 | (05) | MD |
H67984 | (02) | MD |