Provider Demographics
NPI:1285089433
Name:MISHRA, SUPRIYA (MD)
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11500 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2735
Mailing Address - Country:US
Mailing Address - Phone:301-468-4900
Mailing Address - Fax:301-540-3260
Practice Address - Street 1:11500 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2735
Practice Address - Country:US
Practice Address - Phone:301-468-4900
Practice Address - Fax:301-540-3260
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0089776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty