Provider Demographics
NPI:1902629272
Name:MARYLAND SLEEP DOC INC
Entity type:Organization
Organization Name:MARYLAND SLEEP DOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:YERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-802-0664
Mailing Address - Street 1:10348 PUCCINI LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5005 SIGNAL BELL LN STE 210
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2608
Practice Address - Country:US
Practice Address - Phone:408-802-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty