Provider Demographics
NPI:1871527770
Name:MITTAL, PARDEEP KUMAR (MD)
Entity type:Individual
Prefix:
First Name:PARDEEP
Middle Name:KUMAR
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 RESERVE CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1538
Mailing Address - Country:US
Mailing Address - Phone:404-325-3817
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL AND CLINIC
Practice Address - Street 2:DEPT. OF RADIOLOGY - SUITE , A 141
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-712-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0492452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58873Medicare UPIN