Provider Demographics
NPI:1700857554
Name:MITAL, SANGEETA
Entity Type:Individual
Prefix:MS
First Name:SANGEETA
Middle Name:
Last Name:MITAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANGEETA
Other - Middle Name:
Other - Last Name:MITAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17001-0002
Mailing Address - Country:US
Mailing Address - Phone:717-972-2821
Mailing Address - Fax:717-972-2845
Practice Address - Street 1:207 HOUSE AVE STE 110
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2308
Practice Address - Country:US
Practice Address - Phone:717-972-2821
Practice Address - Fax:717-972-2845
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427737207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI12329Medicare UPIN