Provider Demographics
NPI:1538254370
Name:SOOD FAMILY MEDICINE,PA
Entity type:Organization
Organization Name:SOOD FAMILY MEDICINE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-399-9911
Mailing Address - Street 1:1208 E CHURCHVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3484
Mailing Address - Country:US
Mailing Address - Phone:410-399-9911
Mailing Address - Fax:888-493-7135
Practice Address - Street 1:1208 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3442
Practice Address - Country:US
Practice Address - Phone:410-399-9911
Practice Address - Fax:410-803-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041080173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD798502900Medicaid
MD448591200Medicaid
MD359F267MMedicare ID - Type Unspecified
MD798502900Medicaid