Active NPI
Prem P Mittar, MD
- Internal Medicine Physician
- Perrypoint, MD
National Provider Identifier
1396709333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D0043825
- Practice address
- VA.Medical Center
Circle Drive
Perrypoint, MD 21902 - Phone
- (410) 642-2411
- Fax
- (410) 642-1825
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D0043825 | MD | Primary |
Addresses
Primary practice location
VA.Medical Center
Circle Drive
Perrypoint, MD 21902
Mailing address
3202 Glouchester Dr
Fallston, MD 21047-1245
Phone (410) 642-2411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110316000834 | MD | Practitioner - Internal Medicine | 6507048246 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0043825 | MD | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1396709333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3202 GLOUCHESTER DR",
"city": "FALLSTON",
"state": "MD",
"postal_code": "210471245",
"telephone_number": "410-642-2411",
"fax_number": "410-642-1825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VA.MEDICAL CENTER",
"address_2": "CIRCLE DRIVE",
"city": "PERRYPOINT",
"state": "MD",
"postal_code": "21902",
"telephone_number": "410-642-2411",
"fax_number": "410-642-1825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTAR",
"first_name": "PREM",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MD",
"license": "D0043825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perrypoint, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.