Provider Demographics
NPI:1407173610
Name:MISTRY, DIPTI MOHANLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPTI
Middle Name:MOHANLAL
Last Name:MISTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22911 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1617
Mailing Address - Country:US
Mailing Address - Phone:301-824-3343
Mailing Address - Fax:301-824-6323
Practice Address - Street 1:22911 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SMITHSBURG
Practice Address - State:MD
Practice Address - Zip Code:21783-1617
Practice Address - Country:US
Practice Address - Phone:301-824-3343
Practice Address - Fax:301-824-6323
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0078361207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics