Organization
BASANT K. MITTAL, M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASANT KUMAR MITTAL M.D. (PRESIDENT)
(570) 743-5020
Entity
Organization
Contact information
Practice address
3032 N. SUSQUEHANNA TRAIL, ROUTES 11 AND 15, SHAMOKIN DAM, PA 17876-0429
(570) 743-5020
(570) 743-4505
Mailing address
PO BOX 429, 3032 N. SUSQUEHANNA TRAIL-ROUTES 11 AND 15, SHAMOKIN DAM, PA 17876-0429
(570) 743-5020
(570) 743-4505
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD-039080-L
PA
Other
Enumeration date
04/09/2007
Last updated
08/22/2020
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