Provider Demographics
NPI:1265524334
Name:MITRA ARTHRITIS & OSTEOPOROSIS CENTER PC
Entity type:Organization
Organization Name:MITRA ARTHRITIS & OSTEOPOROSIS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVASHIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-282-5244
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:LYNDORA
Mailing Address - State:PA
Mailing Address - Zip Code:16045-0487
Mailing Address - Country:US
Mailing Address - Phone:724-282-5244
Mailing Address - Fax:724-282-5246
Practice Address - Street 1:5 LYN MAR PLAZA
Practice Address - Street 2:
Practice Address - City:LYNDORA
Practice Address - State:PA
Practice Address - Zip Code:16045-1348
Practice Address - Country:US
Practice Address - Phone:724-282-5244
Practice Address - Fax:724-282-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019488860004Medicaid
057744Medicare ID - Type Unspecified