Provider Demographics
NPI:1700965027
Name:PURUSHOTHAMAN, A CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:CATHERINE
Last Name:PURUSHOTHAMAN
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 1:11 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3408
Mailing Address - Country:US
Mailing Address - Phone:301-622-5673
Mailing Address - Fax:
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:WASHINGTON ADVENTIST HOSPITAL
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24071174400000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD55058100Medicaid