Provider Demographics
NPI:1659424976
Name:MAHIPAT, MARLENE NELMA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:NELMA
Last Name:MAHIPAT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 OLD COURT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5243
Mailing Address - Country:US
Mailing Address - Phone:410-655-8900
Mailing Address - Fax:410-655-0498
Practice Address - Street 1:5310 OLD COURT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5243
Practice Address - Country:US
Practice Address - Phone:410-655-8900
Practice Address - Fax:410-655-0498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101943OtherPRIORITY PARTNERS AND EHP
MD666069OtherACN GROUP
DC4J6260001OtherBLUE CROSS BLUE SHIELD
MD7491554OtherAETNA
MD666069OtherUNITED HEALTHCARE
MD910M708FMedicare ID - Type UnspecifiedCHIROPRACTOR