Provider Demographics
NPI:1962620658
Name:ANUSHA SIRITHARA
Entity type:Organization
Organization Name:ANUSHA SIRITHARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRITHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-337-6700
Mailing Address - Street 1:260 GATEWAY DR STE 2122B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4268
Mailing Address - Country:US
Mailing Address - Phone:410-877-2585
Mailing Address - Fax:410-877-2587
Practice Address - Street 1:260 GATEWAY DR STE 2122B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:410-877-2585
Practice Address - Fax:410-877-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962620658OtherCORE SOURCE
1962620658OtherGEHA
1962620658OtherAETNA
1962620658OtherEMBLEM HEALTH
MD-196262020658OtherAMERIGROUP - AMERICAID
1962620658OtherJOHN HOPKINS HEALTH CARE
MD1962620658OtherRIVER SIDE HEALTH CARE
1962620658OtherGOLDEN RULE
1962620658OtherMAIL HANDLERS
1962620658OtherUNITED HEALTH CARE
MD1962620658Medicaid
1962620658OtherBLUE CROSS BLUE SHIELD
1962620658OtherCOVENTRY
1962620658OtherCHAMPUS TRICARE FOR LIFE
1962620658OtherCARE FIRST
MD1962620658OtherGEHA
1962620658OtherCIGNA
MD1962620658OtherPRIORITY PARTNERS
MD1962620658OtherHUMANA
MD1962620658Medicare UPIN
MD1962620658Medicare Oscar/Certification
1962620658Medicare NSC
MD1962620658OtherHUMANA
1962620658OtherBLUE CROSS BLUE SHIELD