Provider Demographics
NPI:1669425179
Name:MITTAR, ASHA RANI (MD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:RANI
Last Name:MITTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7001 JOHNNYCAKE RD
Mailing Address - Street 2:SUITE#200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2406
Mailing Address - Country:US
Mailing Address - Phone:410-719-9110
Mailing Address - Fax:410-719-9122
Practice Address - Street 1:7001 JOHNNYCAKE RD
Practice Address - Street 2:SUITE#200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2406
Practice Address - Country:US
Practice Address - Phone:410-719-9110
Practice Address - Fax:410-719-9122
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD45783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG15563Medicare UPIN
MD810LMedicare ID - Type Unspecified