Provider Demographics
NPI:1003812843
Name:MITAL, AMITA
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:MITAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:STE 115
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3614
Practice Address - Country:US
Practice Address - Phone:412-279-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054527L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015368650003Medicaid
788700HW3Medicare ID - Type Unspecified
PA788700D8SMedicare PIN
PAG10825Medicare UPIN