MEDICARE: RITU S MEDA PA-C

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	4288	CT

General Provider Information

NPI Number	:	1780150458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITU S MEDA PA-C

Provider Business Mailing Address
First Line	:	785 FARMINGTON AVENUE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1673
Country	:	US
Telephone Number	:	860-523-4100
Fax Number	:	860-523-1462

Provider Business Practice Location Address
First Line	:	785 FARMINGTON AVENUE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1673
Country	:	US
Telephone Number	:	860-523-4100
Fax Number	:	860-523-1462

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

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	09/10/2019

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