Provider Demographics
NPI:1376599001
Name:MISHRA & MISHRA, MD, PA
Entity Type:Organization
Organization Name:MISHRA & MISHRA, MD, PA
Other - Org Name:MCLEAN NEUROSCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP/CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAEDEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-356-1105
Mailing Address - Street 1:6845 ELM ST STE 700
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3851
Mailing Address - Country:US
Mailing Address - Phone:703-356-1105
Mailing Address - Fax:703-356-0970
Practice Address - Street 1:6845 ELM ST STE 700
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3851
Practice Address - Country:US
Practice Address - Phone:703-356-1105
Practice Address - Fax:703-356-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
512159Medicare PIN