Healthcare Provider Details

I. General information

NPI: 1639946635
Provider Name (Legal Business Name): MIND HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 BENNING RD NE STE 304
WASHINGTON DC
20002-4588
US

IV. Provider business mailing address

1709 KINGS MANOR DR
BOWIE MD
20721-2001
US

V. Phone/Fax

Practice location:
  • Phone: 301-233-5054
  • Fax: 301-218-1908
Mailing address:
  • Phone: 301-233-5054
  • Fax: 301-218-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ISMAIL M KALOKOH
Title or Position: CEO/PHYSICIAN
Credential: MD
Phone: 301-233-5054