Provider Demographics
NPI:1396709333
Name:MITTAR, PREM P (MD)
Entity type:Individual
Prefix:DR
First Name:PREM
Middle Name:P
Last Name:MITTAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3202 GLOUCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1245
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:410-642-1825
Practice Address - Street 1:VA.MEDICAL CENTER
Practice Address - Street 2:CIRCLE DRIVE
Practice Address - City:PERRYPOINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1825
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0043825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine