| Basant K. Mittal, M.d. P.c. | |
|
3032 N. Susquehanna Trail Routes 11 And 15 Shamokin Dam PA 17876-0429 | |
| (570) 743-5020 | |
| (570) 743-4505 |
| Full Name | Basant K. Mittal, M.d. P.c. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3032 N. Susquehanna Trail, Shamokin Dam, Pennsylvania |
| Authorized Official Name and Position | Basant Kumar Mittal (PRESIDENT) |
| Authorized Official Contact | 5707435020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Basant K. Mittal, M.d. P.c. Po Box 429 3032 N. Susquehanna Trail-routes 11 And 15 Shamokin Dam PA 17876-0429 Ph: (570) 743-5020 | Basant K. Mittal, M.d. P.c. 3032 N. Susquehanna Trail Routes 11 And 15 Shamokin Dam PA 17876-0429 Ph: (570) 743-5020 |
| NPI Number | 1992828396 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992828396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD-039080-L (Pennsylvania) | Primary |
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