Provider Demographics
NPI:1780150458
Name:MEDA, RITU S (PA-C)
Entity type:Individual
Prefix:
First Name:RITU
Middle Name:S
Last Name:MEDA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1673
Mailing Address - Country:US
Mailing Address - Phone:860-523-4100
Mailing Address - Fax:860-523-1462
Practice Address - Street 1:785 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1673
Practice Address - Country:US
Practice Address - Phone:860-523-4100
Practice Address - Fax:860-523-1462
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT4288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant