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General NPI Number Information
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NPI Number | 1295712560
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Entity Type | Individual
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Provider Name | MAKAYA ADISA MULATO M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 190 THOMAS JOHNSON DR STE 5
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City | FREDERICK
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State | MD
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Zip | 21702-4879
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Country | US
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Telephone | 12-007-4444
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Fax | 833-907-0576
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Provider Business Mailing Address
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Address Line | 190 THOMAS JOHNSON DR STE 5
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City | FREDERICK
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State | MD
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Zip | 21702-4879
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Country | US
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Telephone | 301-200-7444
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Fax | 833-907-0576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0057961
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License Number State | MD
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