MEDICARE: MARYLAND INFECTIOUS DISEASE CLINIC, LLC

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	207RI0200X	Infectious Disease Physician	D0056600	MD

General Provider Information

NPI Number	:	1326384116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND INFECTIOUS DISEASE CLINIC, LLC

Provider Business Mailing Address
First Line	:	6097 SEBRING DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3900
Country	:	US
Telephone Number	:	443-794-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	6097 SEBRING DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3900
Country	:	US
Telephone Number	:	443-794-8929
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAN AMLANI
Credential	:	MD
Telephone Number	:	443-794-8929

Provider Enumeration Date	:	12/25/2012
Last Update Date	:	12/25/2012

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