NPIMap

Individual provider Active NPI

Mitul N Dave, MD

  • Internal Medicine Physician
  • Ellicott City, MD
National Provider Identifier
1396833604
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
057313 Issued in MD
Practice address
9055 Chevrolet Drive
Suite 103
Ellicott City, MD 21042
Phone
(410) 465-7950
Fax
(410) 465-3716
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 057313 MD Primary

Addresses

Primary practice location

9055 Chevrolet Drive
Suite 103
Ellicott City, MD 21042

Mailing address

9055 Chevrolet Drive
Suite 103
Ellicott City, MD 21043
Phone (410) 465-7850

Other identifiers 1

IdentifierTypeStateIssuer
374000500MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040424000442 MD Practitioner - Internal MedicinePractitioner - Emergency Medicine 0941296842 Reassigns benefits to 2 organizations
I20090331000024 DC Practitioner - Internal Medicine 0941296842 Reassigns benefits to 2 organizations
Practice locations: Silver Spring, MD

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Health and Wellness Center LLCGroup PAC ID 9335299833, 2 clinicians

Practice addresses (Care Compare)

9055 Chevrolet Dr
Ellicott City, MD 21042-4091
Phone (410) 465-7850

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
057313MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Health & Wellness Center LLC CurrentSince May 12, 2009 Accepting new patients
Juniper Healthcare LLC CurrentSince Jan 27, 2016 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Clinton Nursing, LLC Past Accepting new patients
Marlboro Leasing Co., LLC Past Accepting new patients
313 Hospital Drive Opco LLC Past Accepting new patients
Maryland General Hospital, Inc. Past Accepting new patients
Complete Care at Springbrook LLC Past Accepting new patients
7309 Second Avenue Opco LLC Past Accepting new patients
Winifred Leasing Co., LLC Past Accepting new patients
Sukhdev S. Grover, MD Associates Past Accepting new patients
Primary Health Network Past Accepting new patients
14200 Laurel Park Drive Opco LLC Past Accepting new patients
Livingston Leasing Co., LLC Past Accepting new patients

Locations

6116 Belair Rd
Baltimore, MD 21206
Phone (410) 426-1424

9055 Chevrolet Dr
Ste 103
Ellicott City, MD 21042
Phone (443) 355-6290

9055 Chevrolet Dr
Ellicott City, MD 21042
Phone (410) 465-8990

7420 Marlboro Pike
Forestville, MD 20747
Phone (301) 424-9560

12021 Livingston Rd
#C
Fort Washington, MD 20744
Phone (301) 292-0300

12021 Livingston Rd
Ft Washington, MD 20744
Phone (301) 292-0300

14200 Laurel Park Dr
Laurel, MD 20707
Phone (301) 953-7980

2601 Bel Pre Rd
Silver Spring, MD 20906
Phone (301) 598-6000

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Forestville Heathcare CenterForestville, MD, CCN 215020 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2023
Apr 12, 2025
Ft. Washington Health CenterFt Washington, MD, CCN 215146 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2023
Jun 1, 2023
7309 Second Avenue Opco LLCSykesville, MD, CCN 215136 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2021
Aug 12, 1969
Complete Care at Springbrook LLCSilver Spring, MD, CCN 215052 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398297600000",
    "number": "1396833604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9055 CHEVROLET DRIVE",
            "address_2": "SUITE 103",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21043",
            "telephone_number": "410-465-7850",
            "fax_number": "410-465-3713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9055 CHEVROLET DRIVE",
            "address_2": "SUITE 103",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21042",
            "telephone_number": "410-465-7950",
            "fax_number": "410-465-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVE",
        "first_name": "MITUL",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2014-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "057313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374000500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.