Provider Demographics
NPI:1093028862
Name:SANOVER, TEJAL KISHORE
Entity Type:Individual
Prefix:MISS
First Name:TEJAL
Middle Name:KISHORE
Last Name:SANOVER
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 1:22944 NEWCUT RD # 2302
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9307
Mailing Address - Country:US
Mailing Address - Phone:917-287-8728
Mailing Address - Fax:
Practice Address - Street 1:200 E 16TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4400
Practice Address - Country:US
Practice Address - Phone:301-662-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPT 032386-1225100000X
MD27425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist