Provider Demographics
NPI:1346697760
Name:MUKHTAR, AMAR A (DO)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:A
Last Name:MUKHTAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:301-888-2233
Mailing Address - Fax:
Practice Address - Street 1:7450 ALBERT RD FL 2
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3035
Practice Address - Country:US
Practice Address - Phone:301-888-2233
Practice Address - Fax:301-888-9133
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022053182084P0800X
MDH00899622084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220136400Medicaid