Individual
DR. MUKTA CHANDRA SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-7718
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-7716
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
045364
CT
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
D73674
MD
208M00000X
Hospitalist Physician
045364
CT
208M00000X
Hospitalist Physician
D73878
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548455694
—
MD
Enumeration date
09/12/2007
Last updated
04/09/2015
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