1992816656 NPI number — RITA LUTHRA MD

Table of content: RITA LUTHRA MD (NPI 1992816656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992816656 NPI number — RITA LUTHRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTHRA
Provider First Name:
RITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1992816656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STAFFORD ST STE 265
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01104-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-733-1177
Provider Business Mailing Address Fax Number:
413-733-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STAFFORD ST STE 265
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-1177
Provider Business Practice Location Address Fax Number:
413-733-0425
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  45414 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1022680 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3194078 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000020422 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 045414 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: E05813 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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