Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D25679 | MD |
NPI | 1225072952 |
---|---|
Provider Name | Dr. Nirmala Kammana |
First Address | Glen Burnie, MD 21061-5563 |
Second Address | Glen Burnie, MD 21061-5563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 16/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303451800 | (05) | MD |
57106 | TRICARE (01) | MD |
6181KN | BLUE CROSS BLUE SHEILD (01) | MD |
D78134 | (02) |