Individual
DR. SIDDHARTHA MAHANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4 CENTER DRIVE, ROOM 126 NIH BUILDING 4, BETHESDA, MD 20892-0425
(301) 496-5398
(301) 480-3757
Mailing address
4 CENTER DRIVE, ROOM 126 NIH BUILDING 4, BETHESDA, MD 20892-0425
(301) 496-5398
(301) 480-3757
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
48168
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48168
MEDICAL LICENSE
GA
Enumeration date
07/27/2010
Last updated
07/27/2010
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