Individual
LINCY KOODALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3001 S HANOVER ST, BALTIMORE, MD 21225-1233
(410) 350-3200
Mailing address
3001 S HANOVER ST, BALTIMORE, MD 21225-1233
(410) 350-3200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 167597
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
R167597
MD
Other
Enumeration date
01/18/2016
Last updated
11/14/2022
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