Provider Demographics
NPI:1689686693
Name:TRUMAN F SOUDAH,MD
Entity Type:Organization
Organization Name:TRUMAN F SOUDAH,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUMAN
Authorized Official - Middle Name:FARAH
Authorized Official - Last Name:SOUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:OB,GYN
Authorized Official - Phone:410-661-8690
Mailing Address - Street 1:8813 WALTHAM WOODS RD.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-661-8690
Mailing Address - Fax:410-661-4416
Practice Address - Street 1:8813 WALTHAM WOODS RD.
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:410-661-8690
Practice Address - Fax:410-661-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========OtherCOVENTRY HEALTH PLAN