Provider Demographics
NPI:1982648309
Name:MAITY, SMITA (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:MAITY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4680 POLARIS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5600
Mailing Address - Country:US
Mailing Address - Phone:702-909-5900
Mailing Address - Fax:702-333-4777
Practice Address - Street 1:4680 POLARIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5600
Practice Address - Country:US
Practice Address - Phone:702-909-9300
Practice Address - Fax:702-333-4777
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104832Medicare PIN