Provider Demographics
NPI:1619067659
Name:MEHNDIRATTA, RITULA B (MD)
Entity Type:Individual
Prefix:
First Name:RITULA
Middle Name:B
Last Name:MEHNDIRATTA
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 1:10000 ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-5430
Mailing Address - Country:US
Mailing Address - Phone:240-912-4683
Mailing Address - Fax:240-912-4695
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-912-4683
Practice Address - Fax:240-912-4695
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00583162084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH78695Medicare UPIN
MD632MH126Medicare ID - Type Unspecified
MD403702200Medicaid
MDH78695Medicare UPIN
DC012751P37Medicare ID - Type Unspecified