Provider Demographics
NPI:1912985698
Name:MISHRA, TANUJA (MD)
Entity Type:Individual
Prefix:
First Name:TANUJA
Middle Name:
Last Name:MISHRA
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 1:1701 TWIN SPRINGS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3553
Mailing Address - Country:US
Mailing Address - Phone:443-934-0733
Mailing Address - Fax:410-737-5521
Practice Address - Street 1:1701 TWIN SPRINGS RD STE 140
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3553
Practice Address - Country:US
Practice Address - Phone:443-934-0733
Practice Address - Fax:410-737-5521
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227932207RN0300X
MDD0064782207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012990900Medicaid
H21289Medicare UPIN
MD706LQ390Medicare PIN