Provider Demographics
NPI:1649440322
Name:JINDAL, ANJANA PRASAD (MD)
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:PRASAD
Last Name:JINDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJANA
Other - Middle Name:RAJENDRA
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6220
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:1209 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6220
Practice Address - Country:US
Practice Address - Phone:410-821-9490
Practice Address - Fax:410-821-9495
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433708207W00000X
MDD72657207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD228038ZALLOtherMEDICARE
MDD72657OtherMEDICAL LICENSE