Provider Demographics
NPI:1356322598
Name:JUMANI, SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:
Last Name:JUMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24035 THREE NOTCH RD
Mailing Address - Street 2:P O BOX 640
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-4871
Mailing Address - Country:US
Mailing Address - Phone:301-373-7900
Mailing Address - Fax:301-373-6900
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 202
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-638-7257
Practice Address - Fax:301-705-7628
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2013-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0035295207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4705Medicare PIN
MD000L41S66Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #