Provider Demographics
NPI:1336451517
Name:AHADPOUR, MITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:AHADPOUR
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 1:11421 PATRIOT LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3749
Mailing Address - Country:US
Mailing Address - Phone:301-299-3789
Mailing Address - Fax:
Practice Address - Street 1:11421 PATRIOT LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3749
Practice Address - Country:US
Practice Address - Phone:301-299-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52-2196053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine