| D/b/a Primary Family Health Clinic | |
|
7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 | |
| (410) 719-9110 | |
| (410) 719-9122 |
| Full Name | D/b/a Primary Family Health Clinic |
|---|---|
| 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 |
|---|---|
| D/b/a Primary Family Health Clinic 7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 Ph: (410) 719-9110 | D/b/a Primary Family Health Clinic 7001 Johnnycake Rd Suite#200 Baltimore MD 21244-2418 Ph: (410) 719-9110 |
| NPI Number | 1396929931 |
|---|---|
| Provider Enumeration Date | 12/18/2007 |
| Last Update Date | 12/18/2007 |
| Medicare PECOS PAC ID | 1153590245 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396709333 PECOS PAC ID: 6507048246 Enrollment ID: I20110316000834 |
| Provider Name | Asha R Mittar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669425179 PECOS PAC ID: 5597934687 Enrollment ID: I20110805000588 |
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