Provider Demographics
NPI:1164613378
Name:KISHORE, ANITA R (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:KISHORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:410 W LOMBARD ST APT 608
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1632
Mailing Address - Country:US
Mailing Address - Phone:203-980-6717
Mailing Address - Fax:
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:717-428-0552
Practice Address - Fax:717-428-0518
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD0433932084P0800X
CAC1304502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry