Provider Demographics
NPI:1083343115
Name:DHARA VAISHNAV
Entity Type:Organization
Organization Name:DHARA VAISHNAV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAISHNAV
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-710-5637
Mailing Address - Street 1:8808 CENTRE PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2221
Mailing Address - Country:US
Mailing Address - Phone:410-884-6116
Mailing Address - Fax:410-730-1803
Practice Address - Street 1:8808 CENTRE PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2221
Practice Address - Country:US
Practice Address - Phone:410-884-6116
Practice Address - Fax:410-730-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care