Provider Demographics
NPI:1609851013
Name:RAHEJA, MITA (MD FACC)
Entity Type:Individual
Prefix:
First Name:MITA
Middle Name:
Last Name:RAHEJA
Suffix:
Gender:F
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6855
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-6855
Mailing Address - Country:US
Mailing Address - Phone:330-759-8169
Mailing Address - Fax:330-759-8306
Practice Address - Street 1:3622 BELMONT AVE
Practice Address - Street 2:SUITES 11 AND 12
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1450
Practice Address - Country:US
Practice Address - Phone:330-759-8169
Practice Address - Fax:330-759-8306
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065143207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110228843OtherRAILROAD MEDICARE
341949665027OtherCARESOURCE
000000104933OtherUNISON HEALTH PLAN
OH1542907OtherGATEWAY HEALTH PLAN OF OHIO
1542907OtherAETNA
2500890OtherUNITEDHEALTHCARE
OH000000205226OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH0964774Medicaid
2500890OtherUNITEDHEALTHCARE
OH1542907OtherGATEWAY HEALTH PLAN OF OHIO
OH0964774Medicaid