Healthcare Provider Details

I. General information

NPI: 1306945167
Provider Name (Legal Business Name): USHA A MITTAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TEMPLE OF SERVICE, #666 47TH ST. 9TH SECTOR/KKNAGAR
MADRAS IN
600078
IN

IV. Provider business mailing address

TEMPLE OF SERVICE, #666 47TH ST. 9TH SECTOR/KKNAGAR
MADRAS IN
600078
IN

V. Phone/Fax

Practice location:
  • Phone: 617-964-7326
  • Fax:
Mailing address:
  • Phone: 617-964-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39117
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: