Provider Demographics
NPI:1164139994
Name:NARENDRAN, TUSHAR
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:
Last Name:NARENDRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 LAUREL PL STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6102
Mailing Address - Country:US
Mailing Address - Phone:301-498-1604
Mailing Address - Fax:
Practice Address - Street 1:14405 LAUREL PL STE 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6102
Practice Address - Country:US
Practice Address - Phone:301-498-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist