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General NPI Number Information
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NPI Number | 1366932287
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Entity Type | Individual
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Provider Name | MAMATA BLON PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 5 GARRETT AVE
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City | LA PLATA
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State | MD
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Zip | 20646-5960
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Country | US
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Telephone | 301-609-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 12070 OLD LINE CTR STE 303
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City | WALDORF
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State | MD
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Zip | 20602-3535
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Country | US
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Telephone | 301-645-5100
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Fax | 443-949-0825
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C06809
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License Number State | MD
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