Provider Demographics
NPI:1497733232
Name:MOORTHY, GITA
Entity Type:Individual
Prefix:DR
First Name:GITA
Middle Name:
Last Name:MOORTHY
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 1:2200 S GEORGE ST STE E
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4594
Mailing Address - Country:US
Mailing Address - Phone:717-741-4897
Mailing Address - Fax:717-741-0945
Practice Address - Street 1:2200 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4594
Practice Address - Country:US
Practice Address - Phone:717-741-4897
Practice Address - Fax:717-741-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041431E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75449Medicare UPIN
537637Medicare ID - Type Unspecified