Provider Demographics
NPI:1184470924
Name:MOUDGALYA, HITA SATISH (MD)
Entity type:Individual
Prefix:DR
First Name:HITA
Middle Name:SATISH
Last Name:MOUDGALYA
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 1:2470 N CLARK ST APT 1109
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2737
Mailing Address - Country:US
Mailing Address - Phone:312-931-0448
Mailing Address - Fax:
Practice Address - Street 1:1664 NEIL AVE OFC
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2333
Practice Address - Country:US
Practice Address - Phone:614-293-7706
Practice Address - Fax:614-292-7072
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program