Provider Demographics
NPI:1992811806
Name:SIMLOTE, PRADEEP (MD)
Entity type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:SIMLOTE
Suffix:
Gender:M
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636
Mailing Address - Country:US
Mailing Address - Phone:301-475-7900
Mailing Address - Fax:301-737-4996
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:301-475-7900
Practice Address - Fax:301-475-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052469207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3846650OtherAETNA
MD655BPOtherCAREFIRST
MD475310100Medicaid
F68095Medicare UPIN
MD406SMedicare PIN