Provider Demographics
NPI:1740647510
Name:MAHAT, SARGAM RAJA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARGAM
Middle Name:RAJA
Last Name:MAHAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2624
Mailing Address - Country:US
Mailing Address - Phone:410-916-0383
Mailing Address - Fax:
Practice Address - Street 1:2440 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2802
Practice Address - Country:US
Practice Address - Phone:443-262-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist