Provider Demographics
NPI:1578146056
Name:PITRODA, SIDDH (MD)
Entity Type:Individual
Prefix:
First Name:SIDDH
Middle Name:
Last Name:PITRODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 TWIN OAKS S
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-3305
Mailing Address - Country:US
Mailing Address - Phone:813-245-7703
Mailing Address - Fax:
Practice Address - Street 1:1001 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1605
Practice Address - Country:US
Practice Address - Phone:607-442-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program