MEDICARE: DR. PRITESH R MUTHA M.D., DIPABLM, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MT194941	PA
2	207RG0100X	Gastroenterology Physician	0101257552	VA
3	390200000X	Student in an Organized Health Care Education/Training Program		VA
4	207RG0100X	Gastroenterology Physician	T3831	TX

General Provider Information

NPI Number	:	1386871598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRITESH R MUTHA M.D., DIPABLM, MPH

Provider Business Mailing Address
First Line	:	6400 FANNIN ST STE 1400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1512
Country	:	US
Telephone Number	:	713-704-3450
Fax Number	:	713-704-9938

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 1400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1512
Country	:	US
Telephone Number	:	713-704-3450
Fax Number	:	713-704-9938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	09/30/2022

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