Healthcare Provider Details

I. General information

NPI: 1386679603
Provider Name (Legal Business Name): SOMA MITRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 110
LAUREL MD
20707-5267
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE 110
LAUREL MD
20707-5267
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-8880
  • Fax: 301-498-7939
Mailing address:
  • Phone: 301-498-8880
  • Fax: 301-498-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0070650
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0070650
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: