Healthcare Provider Details

I. General information

NPI: 1699359869
Provider Name (Legal Business Name): DR. MANTHAN RAMKISHAN MIRANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 ROCKVILLE PIKE
ROCKVILLE MD
20852-1133
US

IV. Provider business mailing address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

V. Phone/Fax

Practice location:
  • Phone: 240-238-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD0098095
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0098095
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: