Provider Demographics
NPI:1386679603
Name:MITRA, SOMA (MD)
Entity Type:Individual
Prefix:
First Name:SOMA
Middle Name:
Last Name:MITRA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:23218 BREWERS TAVERN WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4391
Mailing Address - Country:US
Mailing Address - Phone:301-528-8181
Mailing Address - Fax:301-528-8282
Practice Address - Street 1:921 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3252
Practice Address - Country:US
Practice Address - Phone:301-869-6461
Practice Address - Fax:301-869-8960
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-10-21
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Provider Licenses
StateLicense IDTaxonomies
MDD0070650208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine