Healthcare Provider Details

I. General information

NPI: 1497775324
Provider Name (Legal Business Name): UMESH C MULLICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN ROAD # 390
LAUREL MD
20707-5264
US

IV. Provider business mailing address

7350 VAN DUSEN ROAD # 390
LAUREL MD
20707-5264
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-0110
  • Fax: 301-725-0867
Mailing address:
  • Phone: 301-725-0110
  • Fax: 301-725-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0008357
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: