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NPI Code Detail

MEDICARE: SUNITA MALL MD

MEDICARE: SUNITA MALL MD
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
1207R00000XInternal Medicine Physician35083683MOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962455634
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUNITA MALL MD
Provider Business Mailing Address
First Line : 1 PRESTIGE PL STE 550
Second Line :
City : MIAMISBURG
State : OH
Zip : 45342-6115
Country : US
Telephone Number : 937-762-1310
Fax Number : 937-522-8068
Provider Business Practice Location Address
First Line : 405 W GRAND AVE
Second Line :
City : DAYTON
State : OH
Zip : 45405-7538
Country : US
Telephone Number : 937-723-3276
Fax Number : 937-723-3277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 04/06/2022

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Directions to “ SUNITA MALL MD” Practice Location

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