Provider Demographics
NPI:1346220613
Name:NITA RASTOGI FAMILY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NITA RASTOGI FAMILY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-540-1920
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857
Mailing Address - Country:US
Mailing Address - Phone:570-988-0925
Mailing Address - Fax:570-988-0919
Practice Address - Street 1:4701 DEVONSHIRE RD
Practice Address - Street 2:STE 102
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-540-1920
Practice Address - Fax:717-540-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001845670002Medicaid
F91495Medicare UPIN
PA538890Medicare ID - Type Unspecified