=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104538826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIST HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2022
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8403 COLESVILLE RD STE 100
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-6331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-625-0623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 BROADWAY FL 22
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10038-2570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-636-8369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OFFICIAL
-----------------------------------------------------
Name | DR. ALEXANDER SINGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-304-7547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2083B0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------