Healthcare Provider Details

I. General information

NPI: 1497935548
Provider Name (Legal Business Name): MAHINDRANAUTH DEONARINE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD SUIT 308
LANHAM MD
20706-3025
US

IV. Provider business mailing address

9470 ANNAPOLIS RD SUIT 308
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-6655
  • Fax: 301-459-6695
Mailing address:
  • Phone: 301-459-6655
  • Fax: 301-459-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0054926
License Number StateMD

VIII. Authorized Official

Name: MAHINDRANAUTH DEONARINE
Title or Position: PHYSICIAN
Credential: MD PC
Phone: 301-459-6655