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NPI Code Detail

MEDICARE: AMITABHA MITRA MD

MEDICARE: AMITABHA MITRA MD
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
12086S0122XPlastic and Reconstructive Surgery PhysicianMD023302EPA

General Provider Information

NPI Number : 1831187871
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMITABHA MITRA MD
Provider Business Mailing Address
First Line : 1201 GRAMPIAN BLVD
Second Line :
City : WILLIAMSPORT
State : PA
Zip : 17701-1900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 GRAMPIAN BLVD
Second Line :
City : WILLIAMSPORT
State : PA
Zip : 17701-1907
Country : US
Telephone Number : 570-326-8005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 07/24/2023

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Directions to “ AMITABHA MITRA MD” Practice Location

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