Provider Demographics
NPI:1356880850
Name:MINDFUL LIVING INSTITUTE LLC
Entity type:Organization
Organization Name:MINDFUL LIVING INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MANGAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-515-3333
Mailing Address - Street 1:22616 GATEWAY CENTER DR
Mailing Address - Street 2:SUITE #600A
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-2011
Mailing Address - Country:US
Mailing Address - Phone:301-515-3333
Mailing Address - Fax:301-515-3322
Practice Address - Street 1:22616 GATEWAY CENTER DR
Practice Address - Street 2:SUITE #600A
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-2011
Practice Address - Country:US
Practice Address - Phone:301-515-3333
Practice Address - Fax:301-515-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QB0002X, 207R00000X, 208D00000X, 207RB0002X
MDD0058756207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty