Adult and Pediatric Clinic, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

D0061382 Issued in MD

Legal business name

ADULT AND PEDIATRIC CLINIC, PC

Practice address

14816 Physicians LN
Suite 152
Rockville, MD 20850-3944

Phone

(240) 453-0000

Fax

(240) 453-0089

NPI assigned

Nov 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shama Mittal, M.D.NPI 1508865973

Title

Medical Director

Phone

(240) 453-0000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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

• Shama Ravi Mittal, M.D.

  • Pediatrics Physician
  • Rockville, MD
  • NPI 1508865973

  DC

  Medicare reassignment Authorized official
• Fideline Joelle Pokam Mouafo, NP

  • Family Nurse Practitioner
  • New Market, MD
  • NPI 1992548952
  NPD

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1497935605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14816 PHYSICIANS LN",
            "address_2": "SUITE 152",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503944",
            "telephone_number": "240-453-0000",
            "fax_number": "240-453-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14816 PHYSICIANS LN",
            "address_2": "SUITE 152",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503944",
            "telephone_number": "240-453-0000",
            "fax_number": "240-453-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADULT AND PEDIATRIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "SHAMA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "240-453-0000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MD",
            "license": "D0061382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002543700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leonard Stanley Adler, LCSW-C
• Suzanne Mehlhouse Adler, PA-C
• Teshona Adolphe
• Adrienne Inger Nutrition LLC
• Nana A Adu- Amankwa, MD
• Adult Day Health, Inc.
• Adult Day Health, Inc.
• Advagenix
• Advanced Cardiology Center
• Advanced Dermatology of Maryland PC

• General Practice Physician in Rockville, MD
• Providers in Rockville, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.