Mukta Medical Inc

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

D0070832 Issued in MD

Legal business name

MUKTA MEDICAL INC

Practice address

5415 Old Court Rd
Suite 101
Randallstown, MD 21133-5170

Phone

(410) 922-2650

Fax

(410) 922-1612

NPI assigned

Oct 29, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammed Kiddugavu, M.D.NPI 1952446601

Title

Owner

Phone

(410) 922-2650

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammed G Kiddugavu, MD

  • Internal Medicine Physician
  • Randallstown, MD
  • NPI 1952446601

  Infectious Disease

  Medicare reassignment NPD Authorized official
• Anita W. Gathogo, REGISTERED DIETITIAN

  • Obesity and Weight Management Nutrition Registered Dietitian
  • Nottingham, MD
  • NPI 1346429412

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1194197152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4784",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212110784",
            "telephone_number": "410-922-2650",
            "fax_number": "410-922-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 OLD COURT RD",
            "address_2": "SUITE 101",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335170",
            "telephone_number": "410-922-2650",
            "fax_number": "410-922-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUKTA MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "KIDDUGAVU",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-922-2650",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MD",
            "license": "D0070832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "901901400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina A. Morgan, PTA
• Morning Star Group Services Inc
• Celeste Mortenson, C.O.T.A.
• Barnitta Latricia Moses, CPNP
• Vera N Moukam, LGSW
• Multi-Dimensional Community Health Services Inc
• Multi-Dimensional Community Health Services Inc
• Morgan Ariel Murray, CRNP
• Terrianne Nankoma, NP
• Lynn M Nauman, PA-C

• Infectious Disease Physician in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Infectious Disease Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.