Provider Demographics
NPI:1679512099
Name:JALOTA, MUKESH (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:JALOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 AVENLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-3633
Mailing Address - Country:US
Mailing Address - Phone:301-570-5447
Mailing Address - Fax:301-260-1304
Practice Address - Street 1:17300 AVENLEIGH DR
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:MD
Practice Address - Zip Code:20861-3633
Practice Address - Country:US
Practice Address - Phone:301-570-5447
Practice Address - Fax:301-260-1304
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023231207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210581100Medicaid
MD60050001OtherDC BLUE CROSS
VA1679512099Medicaid
MD60059303OtherBLUE CROSS
KY7100149070Medicaid
P00382580OtherRAILROAD MCR
VA010419115Medicaid
MD20047164OtherAMERIHEALTH MERCY HEALTH
NC5909502Medicaid
P00382580OtherRAILROAD MCR
VA1679512099Medicaid
VA010419115Medicaid
MD60059303OtherBLUE CROSS
MD210581100Medicaid