Provider Demographics
NPI:1275735847
Name:SEN, SANU MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANU
Middle Name:MARY
Last Name:SEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HUNTS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9713
Mailing Address - Country:US
Mailing Address - Phone:410-383-6665
Mailing Address - Fax:410-383-6778
Practice Address - Street 1:734 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4431
Practice Address - Country:US
Practice Address - Phone:410-383-6665
Practice Address - Fax:410-383-6778
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLX96OtherPT
MDLX96OtherPT