Provider Demographics
NPI:1528648441
Name:TAMRAKAR, PRAJJWAL (CRNA)
Entity type:Individual
Prefix:
First Name:PRAJJWAL
Middle Name:
Last Name:TAMRAKAR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STOCKMILL RD APT G
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6212
Mailing Address - Country:US
Mailing Address - Phone:713-259-1855
Mailing Address - Fax:
Practice Address - Street 1:30 STOCKMILL RD APT G
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6212
Practice Address - Country:US
Practice Address - Phone:713-259-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR235080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered