Provider Demographics
NPI:1083071120
Name:PATIL, TANUJA
Entity Type:Individual
Prefix:
First Name:TANUJA
Middle Name:
Last Name:PATIL
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:PO BOX 419666
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9666
Mailing Address - Country:US
Mailing Address - Phone:410-970-8190
Mailing Address - Fax:410-313-8314
Practice Address - Street 1:5474 SAINT BARNABAS RD UNIT S
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3622
Practice Address - Country:US
Practice Address - Phone:301-505-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist