Healthcare Provider Details

I. General information

NPI: 1811987308
Provider Name (Legal Business Name): CECILIA MIKITA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4954 N PALMER RD RM 4026
BETHESDA MD
20889-3452
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4510
  • Fax:
Mailing address:
  • Phone: 301-319-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0066707
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: