Provider Demographics
NPI:1275513731
Name:JAIN, RITA (MD)
Entity Type:Individual
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First Name:RITA
Middle Name:
Last Name:JAIN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:830 EXECUTIVE LN
Mailing Address - Street 2:STE 150
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3595
Mailing Address - Country:US
Mailing Address - Phone:321-449-4168
Mailing Address - Fax:321-449-4164
Practice Address - Street 1:835 EXECUTIVE LN
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-8068
Practice Address - Country:US
Practice Address - Phone:321-638-2075
Practice Address - Fax:321-638-2234
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2019-10-18
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Provider Licenses
StateLicense IDTaxonomies
FLME96857207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE85780Medicare UPIN