Healthcare Provider Details

I. General information

NPI: 1447316708
Provider Name (Legal Business Name): SRIKANTH MITTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/20/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 SARATOGA RD STE 400
WILTON NY
12831-1694
US

IV. Provider business mailing address

665 SARATOGA RD SUITE 400
SARATOGA SPRINGS NY
12866-2134
US

V. Phone/Fax

Practice location:
  • Phone: 518-580-2185
  • Fax:
Mailing address:
  • Phone: 518-580-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number321014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: