1104863463 NPI number — MEHNDIRATTA, PA

Table of content: (NPI 1104863463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104863463 NPI number — MEHNDIRATTA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEHNDIRATTA, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104863463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20015-0330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-498-2922
Provider Business Mailing Address Fax Number:
301-498-3074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3411 OLANDWOOD CT
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-1488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-924-0452
Provider Business Practice Location Address Fax Number:
301-498-3074
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEHNDIRATTA
Authorized Official First Name:
YASH
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
301-466-7485

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KFT2ME . This is a "GROUP PROVIDER# CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J082 . This is a "GROUP PROVIDER# CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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