Provider Demographics
NPI:1316030281
Name:POYDRAS, URSULA DENISE (MD)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:DENISE
Last Name:POYDRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 GREENBELT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2265
Mailing Address - Country:US
Mailing Address - Phone:301-552-5862
Mailing Address - Fax:301-552-5864
Practice Address - Street 1:9821 GREENBELT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2269
Practice Address - Country:US
Practice Address - Phone:301-552-5862
Practice Address - Fax:301-552-5864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42448174400000X
MD00D42448207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD562627117OtherTAX ID
MD757841500Medicaid
MD757841500Medicaid
MDF31740Medicare UPIN