Provider Demographics
NPI:1871671693
Name:DAVE, RITU (MD)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:DAVE
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 1:1891 KIRTS BLVD APT 115
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4370
Mailing Address - Country:US
Mailing Address - Phone:516-659-4079
Mailing Address - Fax:516-908-4351
Practice Address - Street 1:1 GENERAL STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:516-659-4079
Practice Address - Fax:516-908-4351
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78376207RC0200X
MA246297207RC0200X
NY216391-1207RP1001X, 207RS0012X
FLME129946207RC0200X
NY216391207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A783760Medicaid
CA00A783760Medicaid
G36297Medicare UPIN