Provider Demographics
NPI:1316979636
Name:DIAA Y. MIKHAIL, M.D., P.A.
Entity type:Organization
Organization Name:DIAA Y. MIKHAIL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIAA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-288-5901
Mailing Address - Street 1:1105 N POINT BLVD
Mailing Address - Street 2:SUITE 708
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3419
Mailing Address - Country:US
Mailing Address - Phone:410-288-5901
Mailing Address - Fax:410-288-5904
Practice Address - Street 1:1105 N POINT BLVD
Practice Address - Street 2:SUITE 708
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3419
Practice Address - Country:US
Practice Address - Phone:410-288-5901
Practice Address - Fax:410-288-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADG2297OtherRAILROAD MEDICARE
MDKAV9DIOtherCAREFIRST
MD199301100OtherMEDICAL ASSISTANCE
MD271MOtherMEDICARE
DCS344 0001OtherCAREFIRST