Provider Demographics
NPI:1245284454
Name:TOMER, MEENAKSHI (CRNP)
Entity type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:TOMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:
Other - Last Name:KHATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8791
Mailing Address - Fax:410-328-1048
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8791
Practice Address - Fax:410-328-1048
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD536202400Medicaid
MD820465-02OtherBLUE CROSS/BLUE SHIELD
MD110191262Medicare PIN
MD820465-02OtherBLUE CROSS/BLUE SHIELD
S90449Medicare UPIN