Individual
DR. MARK VIKAS MISHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 UPPER CHESAPEAKE DRIVE RADIATION ONCOLOGY, UPPER CHESAPEAKE MEDICAL CENTER, BEL AIR, MD 21014-4324
(443) 843-5609
Mailing address
500 UPPER CHESAPEAKE DRIVE RADIATION ONCOLOGY, UPPER CHESAPEAKE MEDICAL CENTER, BEL AIR, MD 21014-4324
(443) 843-5609
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125-055026
IL
2085R0001X
Radiation Oncology Physician
Primary
MT194731
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D75962
LICENSE NUMBER
MD
01
—
MT 194731
STATE MEDICAL LICENSE
PA
Enumeration date
08/21/2008
Last updated
09/20/2013
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