Provider Demographics
NPI:1215965165
Name:DAS, MUKUL (MD)
Entity type:Individual
Prefix:
First Name:MUKUL
Middle Name:
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUTE T-20
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MHD00557452085R0202X
MDD00557452085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005193M14Medicare ID - Type UnspecifiedMONTGOMERY COMMUNITY MAGN
005195K90Medicare ID - Type UnspecifiedDRS. KORSOWER & PION RADI
G24185Medicare UPIN
980MJ846Medicare ID - Type UnspecifiedFREDERICK
005194C10Medicare ID - Type UnspecifiedCOMMUNITY RADIOLOGY ASSOC