Provider Demographics
NPI:1770588196
Name:LOTHE, MEENAL S (MD)
Entity type:Individual
Prefix:
First Name:MEENAL
Middle Name:S
Last Name:LOTHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MENAL
Other - Middle Name:S
Other - Last Name:PADGAONKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1725
Mailing Address - Country:US
Mailing Address - Phone:404-256-0775
Mailing Address - Fax:404-459-8426
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1725
Practice Address - Country:US
Practice Address - Phone:404-256-0775
Practice Address - Fax:404-459-8426
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506836Medicaid
OH2506836Medicaid
OH4142935Medicare PIN
OH4142931Medicare PIN
OH4142932Medicare PIN