Provider Demographics
NPI:1295712560
Name:MULATO, MAKAYA ADISA (MD)
Entity type:Individual
Prefix:DR
First Name:MAKAYA
Middle Name:ADISA
Last Name:MULATO
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 1:3520 SUGARLOAF PKWY STE F03
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7911
Mailing Address - Country:US
Mailing Address - Phone:301-200-7444
Mailing Address - Fax:
Practice Address - Street 1:190 THOMAS JOHNSON DR STE 5
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:012-007-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412401400Medicaid