Healthcare Provider Details

I. General information

NPI: 1356880850
Provider Name (Legal Business Name): MINDFUL LIVING INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22616 GATEWAY CENTER DR SUITE #600A
CLARKSBURG MD
20871-2011
US

IV. Provider business mailing address

22616 GATEWAY CENTER DR SUITE #600A
CLARKSBURG MD
20871-2011
US

V. Phone/Fax

Practice location:
  • Phone: 301-515-3333
  • Fax: 301-515-3322
Mailing address:
  • Phone: 301-515-3333
  • Fax: 301-515-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberD0058756
License Number StateMD

VIII. Authorized Official

Name: DR. HARPAL SINGH MANGAT
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 301-515-3333