Provider Demographics
NPI:1174813448
Name:JHAVERI, MAMTA BHASKER (MD)
Entity Type:Individual
Prefix:
First Name:MAMTA
Middle Name:BHASKER
Last Name:JHAVERI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:601 N CAROLINE ST FL STREET8
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-5933
Practice Address - Fax:410-502-2309
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2022-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD80191207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology