Organization
SUPRIYA JAGANNATH MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPRIYA BANAD JAGANNATH M.D. (OWNER)
(410) 476-7511
Entity
Organization
Contact information
Practice address
100 E CARROLL ST, SALISBURY, MD 21801-5422
(410) 543-7530
Mailing address
PO BOX 2181, SALISBURY, MD 21802-2181
(410) 476-7511
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0064112
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411276800
—
MD
Enumeration date
04/28/2008
Last updated
04/28/2008
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