Provider Demographics
NPI:1356434310
Name:LODHA, SMITA (MD)
Entity type:Individual
Prefix:MRS
First Name:SMITA
Middle Name:
Last Name:LODHA
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 1:9606 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1046
Mailing Address - Country:US
Mailing Address - Phone:718-335-4747
Mailing Address - Fax:718-476-2626
Practice Address - Street 1:9606 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1046
Practice Address - Country:US
Practice Address - Phone:718-335-4747
Practice Address - Fax:718-476-2626
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020762Medicaid
01005BOtherMEDICARE ID
NY02020762Medicaid