Provider Demographics
NPI:1497392229
Name:KOWTHA, BRAMARAMBA
Entity Type:Individual
Prefix:
First Name:BRAMARAMBA
Middle Name:
Last Name:KOWTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 CRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3052
Mailing Address - Country:US
Mailing Address - Phone:301-379-7165
Mailing Address - Fax:
Practice Address - Street 1:8009 CRADDOCK RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3052
Practice Address - Country:US
Practice Address - Phone:301-379-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD826948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered