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General NPI Number Information
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NPI Number | 1871373357
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Entity Type | Organization
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Legal Business Name | MAMMOTH HEALTH, PLLC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 6504 BROOKES HILL CT
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City | BETHESDA
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State | MD
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Zip | 20816-2501
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Country | US
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Telephone | 315-508-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 6504 BROOKES HILL CT
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City | BETHESDA
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State | MD
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Zip | 20816-2501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | ROBERT MORDKIN
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Credential | MD
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Telephone | 315-508-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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