Provider Demographics
NPI:1043565401
Name:PADICKAKUDI, OUSEPH JANSO (MBBCH)
Entity Type:Individual
Prefix:DR
First Name:OUSEPH
Middle Name:JANSO
Last Name:PADICKAKUDI
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:DR
Other - First Name:JANSON
Other - Middle Name:
Other - Last Name:PADICKAKUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBCH
Mailing Address - Street 1:1804 E. PRATT STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N. WOLFE STREET, 655 BLALOCK
Practice Address - Street 2:JOHNS HOPKINS HOSPITAL, DEPARTMENT OF SURGERY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-502-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ7059103208600000X
MDP28117390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery