Provider Demographics
NPI:1225072952
Name:KAMMANA, NIRMALA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:
Last Name:KAMMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAMMANA
Other - Middle Name:
Other - Last Name:NIRMALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1916 CRAIN HWY S
Mailing Address - Street 2:SUITE NUMBER 1
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5563
Mailing Address - Country:US
Mailing Address - Phone:410-760-1930
Mailing Address - Fax:410-760-1717
Practice Address - Street 1:1916 CRAIN HWY S
Practice Address - Street 2:SUITE NUMBER 1
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5563
Practice Address - Country:US
Practice Address - Phone:410-760-1930
Practice Address - Fax:410-760-1717
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD256792080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303451800Medicaid
MD57106OtherTRICARE
MD6181KNOtherBLUE CROSS BLUE SHEILD
MD6181KNOtherBLUE CROSS BLUE SHEILD
D78134Medicare UPIN