Healthcare Provider Details

I. General information

NPI: 1720172737
Provider Name (Legal Business Name): MANOJ K MITTAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CORPORATE DR
EASTON PA
18045-2670
US

IV. Provider business mailing address

41 CORPORATE DR
EASTON PA
18045-2670
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax:
Mailing address:
  • Phone: 484-526-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD043211E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: