Healthcare Provider Details

I. General information

NPI: 1538177746
Provider Name (Legal Business Name): MILDRED SARTEE PRAH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 SPRING VILLAGE DR
SPRINGFIELD VA
22150-4446
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 703-923-4644
  • Fax: 703-923-4625
Mailing address:
  • Phone: 703-923-4644
  • Fax: 703-923-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number01468
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: