Individual
MAMATA BLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(301) 609-4000
Mailing address
12070 OLD LINE CTR, STE 303, WALDORF, MD 20602-3535
(301) 645-5100
(443) 949-0825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C06809
MD
Other
Enumeration date
05/16/2018
Last updated
09/18/2020
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