MEDICARE: MITUL VORA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	22164	MD
2	183500000X	Pharmacist	A10004570	DE

General Provider Information

NPI Number	:	1093128290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITUL VORA

Provider Business Mailing Address
First Line	:	10119 OLD OCEAN CITY BLVD
Second Line	:
City	:	BERLIN
State	:	MD
Zip	:	21811-1143
Country	:	US
Telephone Number	:	404-539-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	10119 OLD OCEAN CITY BLVD
Second Line	:
City	:	BERLIN
State	:	MD
Zip	:	21811-1143
Country	:	US
Telephone Number	:	404-539-0194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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Directions to “ MITUL VORA ” Practice Location

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