Provider Demographics
NPI:1275787764
Name:MUKUL PATHARKAR, M.D, LLC
Entity Type:Organization
Organization Name:MUKUL PATHARKAR, M.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUL
Authorized Official - Middle Name:VASANT
Authorized Official - Last Name:PATHARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-247-9526
Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4309
Mailing Address - Country:US
Mailing Address - Phone:443-643-3106
Mailing Address - Fax:443-643-1450
Practice Address - Street 1:602 S ATWOOD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4172
Practice Address - Country:US
Practice Address - Phone:410-588-5681
Practice Address - Fax:410-588-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067952207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty