| |
7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 | |
(410) 719-9110 | |
(410) 719-9122 |
Full Name | |
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Speciality | Family Medicine |
Location | 7001 Johnnycake Rd, Baltimore, Maryland |
Authorized Official Name and Position | Asha Rani Mittar (PHYSCIAN/OWNER) |
Authorized Official Contact | 4107199110 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 Ph: (410) 719-9110 | 7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 Ph: (410) 719-9110 |
NPI Number | 1396929931 |
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Provider Enumeration Date | 12/18/2007 |
Last Update Date | 12/18/2007 |
Medicare PECOS PAC ID | 1153590245 |
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Medicare Enrollment ID | O20110805000549 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396929931 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | D45783 (Maryland) | Primary |
Provider Name | Prem P Mittar |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1396709333 PECOS PAC ID: 6507048246 Enrollment ID: I20110316000834 |
Provider Name | Asha R Mittar |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1669425179 PECOS PAC ID: 5597934687 Enrollment ID: I20110805000588 |
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