Provider Demographics
NPI:1386699247
Name:UMAMAHESWARAN, MALLIKA (MD)
Entity type:Individual
Prefix:
First Name:MALLIKA
Middle Name:
Last Name:UMAMAHESWARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 KEY WEST AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3960
Mailing Address - Country:US
Mailing Address - Phone:301-424-2400
Mailing Address - Fax:
Practice Address - Street 1:9850 KEY WEST AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3960
Practice Address - Country:US
Practice Address - Phone:301-424-2400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD353342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine