Provider Demographics
NPI:1376574061
Name:MEHROTRA, RITU G (MD)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:G
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:477 OTTER LN S
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8363
Mailing Address - Country:US
Mailing Address - Phone:561-422-7577
Mailing Address - Fax:561-422-7615
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:PRIMARY CARE (110)
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-7577
Practice Address - Fax:561-422-7615
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVADOOMedicare UPIN