Adult And Pediatric Clinic, Pc | |
14816 Physicians Ln Suite 152 Rockville MD 20850-3944 | |
(240) 453-0000 | |
(240) 453-0089 |
Full Name | Adult And Pediatric Clinic, Pc |
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Speciality | General Practice |
Location | 14816 Physicians Ln, Rockville, Maryland |
Authorized Official Name and Position | Shama Mittal (MEDICAL DIRECTOR) |
Authorized Official Contact | 2404530000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Adult And Pediatric Clinic, Pc 14816 Physicians Ln Suite 152 Rockville MD 20850-3944 Ph: (240) 453-0000 | Adult And Pediatric Clinic, Pc 14816 Physicians Ln Suite 152 Rockville MD 20850-3944 Ph: (240) 453-0000 |
NPI Number | 1497935605 |
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Provider Enumeration Date | 11/06/2007 |
Last Update Date | 05/14/2008 |
Medicare PECOS PAC ID | 4183674450 |
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Medicare Enrollment ID | O20050125000319 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497935605 | NPI | - | NPPES |
002543700 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | D0061382 (Maryland) | Primary |
Provider Name | Shama R Mittal |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1508865973 PECOS PAC ID: 0749250561 Enrollment ID: I20040908000794 |
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