Provider Demographics
NPI:1700973484
Name:KAPOOR, SURRINDER S (MD)
Entity Type:Individual
Prefix:
First Name:SURRINDER
Middle Name:S
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:2336 GODDARD PARKWAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00527662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
100026410OtherAMERICAN PSYCH SYSTEM
576618OtherUNITED HEALTH CARE MAMSI
MD609550001Medicaid
MD609550004Medicaid
MDLM49EAOtherCAREFIRST BCBS GROUP
MD522156095OtherUNITED BEHAVIORAL HEALTH
733634OtherNCPPO PIN
R968OtherCARE1ST FEDERAL GROUP DC
0002OtherCAREFIRST FEDERAL PIN DC
MD252972000OtherMAGELLAN PIN
MD522156095OtherAETNA
MD85070704OtherCAREFIRST BCBS PIN
MD259147000OtherMAGELLAN GROUP
MD609550002Medicaid
5221560950001OtherTRICARE
MD141675OtherVALUE OPTIONS
517251OtherUHC MAMSI GROUP #
576618OtherUNITED HEALTH CARE MAMSI
G73112Medicare UPIN
5221560950001OtherTRICARE