Provider Demographics
NPI:1063791119
Name:MADAN, ANKIT (MBBS)
Entity type:Individual
Prefix:
First Name:ANKIT
Middle Name:
Last Name:MADAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 SURRATTS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-877-4673
Mailing Address - Fax:301-877-5622
Practice Address - Street 1:7501 SURRATTS RD STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-877-4673
Practice Address - Fax:301-877-5622
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101261596207RH0003X
390200000X
MDD0093602207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program