Provider Demographics
NPI:1184891871
Name:BATTA, MARI MUMTA (DO)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:MUMTA
Last Name:BATTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2701 DEKALB PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1852
Mailing Address - Country:US
Mailing Address - Phone:610-272-7546
Mailing Address - Fax:610-272-1064
Practice Address - Street 1:2701 DEKALB PIKE
Practice Address - Street 2:SUITE 108
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-272-7546
Practice Address - Fax:610-272-1064
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014151207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102850788Medicaid
PA295876YTAVMedicare PIN