Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D87224 | MD |
NPI | 1003260373 |
---|---|
Provider Name | Sujina Pradhan |
First Address | Burtonsville, MD 20866-5601 |
Second Address | Roanoke, VA 24014-1838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 20/08/2020 |