Provider Demographics
NPI:1235496233
Name:PUNNOOSE, ANSU MATHEW (DO)
Entity type:Individual
Prefix:DR
First Name:ANSU
Middle Name:MATHEW
Last Name:PUNNOOSE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:8175 WESTSIDE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2708
Mailing Address - Country:US
Mailing Address - Phone:240-580-2650
Mailing Address - Fax:240-580-2651
Practice Address - Street 1:8175 WESTSIDE BLVD STE D
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2708
Practice Address - Country:US
Practice Address - Phone:240-580-2650
Practice Address - Fax:240-580-2651
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2023-10-09
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Provider Licenses
StateLicense IDTaxonomies
MDH0079559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine