Organization
MAHESH MOONDRA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHESH MOONDRA MD (OWNER)
(410) 546-5954
Entity
Organization
Contact information
Practice address
106 MILFORD ST, SUITE 504B, SALISBURY, MD 21804-6953
(410) 546-5954
(410) 219-3038
Mailing address
106 MILFORD ST, SUITE 504B, SALISBURY, MD 21804-6953
(410) 546-5954
(410) 219-3038
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D32014
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000875602
MADE
—
01
—
000799857
AMERIHEALTH
—
01
—
110140803
MBRR
—
01
—
191308
AMERIGROUP
—
01
—
21728011
UHC
—
01
—
251300
BSVA
—
01
—
30773
PP
—
01
—
32014
DHP
—
01
—
4393240
AETN
—
01
—
510427
USHC
—
01
—
545418200
MAMD
—
05
—
545418200
—
MD
01
—
843455
MAMS
—
01
—
E475
BSDC
—
01
—
KA67MA
BSMD
—
Enumeration date
07/07/2005
Last updated
03/23/2020
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