Healthcare Provider Details

I. General information

NPI: 1063791119
Provider Name (Legal Business Name): ANKIT MADAN M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS RD STE 101
CLINTON MD
20735-3362
US

IV. Provider business mailing address

7501 SURRATTS RD STE 101
CLINTON MD
20735-3362
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-4673
  • Fax: 301-877-5622
Mailing address:
  • Phone: 301-877-4673
  • Fax: 301-877-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101261596
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0093602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: