Healthcare Provider Details

I. General information

NPI: 1891409561
Provider Name (Legal Business Name): MIST PHYSICIAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 COLESVILLE RD STE 100
SILVER SPRING MD
20910-6331
US

IV. Provider business mailing address

222 BROADWAY FL 22
NEW YORK NY
10038-2570
US

V. Phone/Fax

Practice location:
  • Phone: 844-625-0623
  • Fax:
Mailing address:
  • Phone: 844-625-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXANDER SINGH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 844-625-0623