Organization
ISTAT TELEMEDICINE PROVIDERS L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARDDHY BULANADI RODRIGUEZ CRNP (CEO)
(240) 354-4087
Entity
Organization
Contact information
Practice address
128 LUCCA LN, ABINGDON, MD 21009-1476
(202) 876-2879
Mailing address
128 LUCCA LN, ABINGDON, MD 21009-1476
(240) 354-4087
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363LA2100X
Acute Care Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
11/11/2020
Last updated
02/03/2021
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