Provider Demographics
NPI:1982134805
Name:RIDOUT, TRINA CHAKRABORTTY
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:CHAKRABORTTY
Last Name:RIDOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3902
Mailing Address - Country:US
Mailing Address - Phone:410-516-5270
Mailing Address - Fax:410-416-4784
Practice Address - Street 1:1 E 31ST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3902
Practice Address - Country:US
Practice Address - Phone:410-516-9270
Practice Address - Fax:410-516-4784
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD89795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine