Individual provider Active NPI

Makaya Adisa Mulato, M.D.

  • Pediatrics Physician
  • Frederick, MD
National Provider Identifier
1295712560
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0057961 Issued in MD
Practice address
190 Thomas Johnson Dr Ste 5
Frederick, MD 21702-4879
Phone
(012) 007-4444
Fax
(833) 907-0576
NPI assigned
Dec 28, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0057961 MD Primary

Addresses

Primary practice location

190 Thomas Johnson Dr Ste 5
Frederick, MD 21702-4879

Mailing address

190 Thomas Johnson Dr Ste 5
Frederick, MD 21702-4879
Phone (301) 200-7444

Other practice location 1

87 Thomas Johnson Dr
Suite 101
Frederick, MD 21702-4301
Phone (301) 694-0606

Other identifiers 1

IdentifierTypeStateIssuer
412401400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0057961MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
All About Kids Pediatrics LLC Pediatrics CurrentSince May 1, 2021 Accepting new patients
Frederick Health Hospital Inc PastSince May 1, 2021 Accepting new patients

Locations

190 Thomas Johnson Dr
Ste 5
Frederick, MD 21702
Phone (301) 200-7444

3520 Sugarloaf Pkwy
Ste F03
Urbana, MD 21704
Phone (443) 221-8716

Interoperability endpoints

  • Direct secure messaging: makaya.mulato.1@24649.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/24649/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1295712560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 THOMAS JOHNSON DR STE 5",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024879",
            "telephone_number": "301-200-7444",
            "fax_number": "833-907-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 THOMAS JOHNSON DR STE 5",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024879",
            "telephone_number": "012-007-4444",
            "fax_number": "833-907-0576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "87 Thomas Johnson Dr",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024301",
            "country_code": "US",
            "telephone_number": "301-694-0606",
            "fax_number": "301-662-6928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULATO",
        "first_name": "MAKAYA",
        "middle_name": "ADISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0057961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412401400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.