Healthcare Provider Details

I. General information

NPI: 1184541617
Provider Name (Legal Business Name): MOHIT MITTAL RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 KING AVE
NOTTINGHAM MD
21236-3811
US

IV. Provider business mailing address

4807 KING AVE
NOTTINGHAM MD
21236-3811
US

V. Phone/Fax

Practice location:
  • Phone: 775-462-1645
  • Fax:
Mailing address:
  • Phone: 775-462-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX8545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: