Provider Demographics
NPI:1245222082
Name:TALWAR, SIMITA U (MD)
Entity Type:Individual
Prefix:
First Name:SIMITA
Middle Name:U
Last Name:TALWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIMITA
Other - Middle Name:B
Other - Last Name:DAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1302 CRONSON BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2064
Mailing Address - Country:US
Mailing Address - Phone:410-451-1301
Mailing Address - Fax:410-451-1037
Practice Address - Street 1:1302 CRONSON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2064
Practice Address - Country:US
Practice Address - Phone:410-451-1301
Practice Address - Fax:410-451-1037
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403467800Medicaid
MD7611526OtherAETNA FEE FOR SERVICE
MD2162109OtherMAMSI SPECIALIST
MD7605-0064OtherCAREFIRST BLUECHOICE
MD5802923OtherCIGNA PIN
MD121128OtherJHHC PROVIDER NUMBER
MD3352166OtherAETNA CAPITATED
MD629962-02OtherCAREFIRST MD RENDERING
MDP16222OtherCAREFIRST MPOS
MD8162109OtherMAMSI PRIMARY CARE
MDP00137877OtherRR MEDICARE
H98077Medicare UPIN
MD403467800Medicaid