Individual
NIRANDRA MAHAMITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
504 WHITE HORSE PIKE, HADDON HEIGHTS, NJ 08035
(856) 546-7990
Mailing address
1 FEDERAL ST # 200, CAMDEN, NJ 08103-1088
(856) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA082818
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010046054
AMERICHOICE
—
05
—
0141569
—
NJ
01
—
1635355
AETNA
—
01
—
2861061000
AMERIHEALTH, KEYSTONE, IBC
—
01
—
6483065
CIGNA
—
01
—
MA082818
NJ MEDICAL LICENSE
NJ
01
—
P00428381
RR MEDICARE
—
Enumeration date
08/08/2007
Last updated
09/12/2019
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