Organization
ADULT AND PEDIATRIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAMA MITTAL M.D. (MEDICAL DIRECTOR)
(240) 453-0000
Entity
Organization
Contact information
Practice address
14816 PHYSICIANS LN, SUITE 152, ROCKVILLE, MD 20850-3944
(240) 453-0000
(240) 453-0089
Mailing address
14816 PHYSICIANS LN, SUITE 152, ROCKVILLE, MD 20850-3944
(240) 453-0000
(240) 453-0089
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
D0061382
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002543700
—
MD
Enumeration date
11/06/2007
Last updated
05/14/2008
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