Healthcare Provider Details

I. General information

NPI: 1518005636
Provider Name (Legal Business Name): MARTIN MAHENDRA SARKAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9093 RIDGEFIELD DR STE 104
FREDERICK MD
21701-6711
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 240-956-5475
  • Fax: 240-891-2600
Mailing address:
  • Phone: 240-439-8913
  • Fax: 240-439-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number57553
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberH80011
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: