Provider Demographics
NPI:1013541150
Name:PUTHENPURACKAL, THANKAMMA
Entity Type:Individual
Prefix:
First Name:THANKAMMA
Middle Name:
Last Name:PUTHENPURACKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 QUEENSBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1922
Mailing Address - Country:US
Mailing Address - Phone:202-746-6939
Mailing Address - Fax:
Practice Address - Street 1:3620 15TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3005
Practice Address - Country:US
Practice Address - Phone:202-526-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant