Healthcare Provider Details

I. General information

NPI: 1518969666
Provider Name (Legal Business Name): MUKESH P. LUHAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD SUITE 9
BALTIMORE MD
21222-2132
US

IV. Provider business mailing address

10108 PASTURE GATE LN
COLUMBIA MD
21044-1738
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-2992
  • Fax: 410-282-2966
Mailing address:
  • Phone: 410-282-2992
  • Fax: 410-282-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0024303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: