Organization
MIRA MACE MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAGADEESH JAGARLAMUDI (OPERATIONS ADMINISTRATOR)
(332) 296-0021
Entity
Organization
Contact information
Practice address
11810 GRAND PARK AVE STE 500, NORTH BETHESDA, MD 20852-8679
(332) 296-0021
Mailing address
1111B S GOVERNORS AVE STE 39475, DOVER, DE 19904-6903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
08/21/2025
Last updated
02/02/2026
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