Provider Demographics
NPI:1831323161
Name:MITAL, ANUBHAV (MD)
Entity Type:Individual
Prefix:
First Name:ANUBHAV
Middle Name:
Last Name:MITAL
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 1:1010 CEREAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2776
Mailing Address - Country:US
Mailing Address - Phone:513-867-2622
Mailing Address - Fax:513-844-2093
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-867-2622
Practice Address - Fax:513-844-2093
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH098991207R00000X
OH35.098991208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086059Medicaid