Provider Demographics
NPI:1922043561
Name:KULKARNI, SANJEEVANI TAKEMALKER (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEVANI
Middle Name:TAKEMALKER
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:1020 EDGEWOOD RD
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-0856
Mailing Address - Country:US
Mailing Address - Phone:410-679-5755
Mailing Address - Fax:410-679-6613
Practice Address - Street 1:1020 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040
Practice Address - Country:US
Practice Address - Phone:410-679-5755
Practice Address - Fax:410-679-6613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO27265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS21995Medicare ID - Type Unspecified
D76521Medicare UPIN