Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD423827 | PA |
N | 208000000X | Pediatrician | MD423827 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD423827 | PA |
NPI | 1316968167 |
---|---|
Provider Name | Manoj K Mittal |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 05/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0083071 | (05) | NJ |
101408400 | (05) | PA |
H41919 | (02) |