Provider Demographics
NPI:1619259991
Name:TALIM, RADHIKA DEEPAK (PT)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:DEEPAK
Last Name:TALIM
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 1:7200 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5201
Mailing Address - Country:US
Mailing Address - Phone:410-795-8800
Mailing Address - Fax:
Practice Address - Street 1:7200 THIRD AVE
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5201
Practice Address - Country:US
Practice Address - Phone:410-795-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032584225100000X
MD24022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400056271Medicare PIN
NYA400057354Medicare PIN
NYA400057352Medicare PIN