Provider Demographics
NPI:1366513889
Name:MISRA, BRAJENDRA NATH (MD,MS,FACS)
Entity type:Individual
Prefix:DR
First Name:BRAJENDRA
Middle Name:NATH
Last Name:MISRA
Suffix:
Gender:M
Credentials:MD,MS,FACS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7220 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2004
Mailing Address - Country:US
Mailing Address - Phone:301-220-0088
Mailing Address - Fax:301-220-1005
Practice Address - Street 1:7220 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2004
Practice Address - Country:US
Practice Address - Phone:301-220-0088
Practice Address - Fax:301-220-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD20069208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD791491100Medicaid
MDC 62100Medicare UPIN
MD791491100Medicaid