Provider Demographics
NPI:1609823798
Name:CHITAKKI, RITU (MD)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:CHITAKKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 LAUREL FORT MEADE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2040
Mailing Address - Country:US
Mailing Address - Phone:301-490-3088
Mailing Address - Fax:301-490-2575
Practice Address - Street 1:3450 LAUREL FORT MEADE RD STE 207
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-490-3088
Practice Address - Fax:301-490-2575
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336602200Medicaid
MD000P31133Medicare ID - Type Unspecified
MD336602200Medicaid