Provider Demographics
NPI:1376887133
Name:THOUNDAYIL, LEELA MARIAM (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEELA
Middle Name:MARIAM
Last Name:THOUNDAYIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BOSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4011
Mailing Address - Country:US
Mailing Address - Phone:410-512-3200
Mailing Address - Fax:
Practice Address - Street 1:720 BOSLEY AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4011
Practice Address - Country:US
Practice Address - Phone:410-512-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant