Provider Demographics
NPI:1467615500
Name:MITSANI, DIMITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRA
Middle Name:
Last Name:MITSANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:410-383-2072
Mailing Address - Fax:412-648-6399
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-383-2072
Practice Address - Fax:410-383-0054
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190016207RI0200X
MDD70785207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD901901400Medicaid
MD901901400Medicaid