Individual
TARA MAHANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 KERNAN DR, BALTIMORE, MD 21207-6665
(410) 448-6323
Mailing address
2200 KERNAN DR, BALTIMORE, MD 21207-6665
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4752
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093575100
—
MD
Enumeration date
03/16/2015
Last updated
03/16/2015
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