Healthcare Provider Details

I. General information

NPI: 1609851013
Provider Name (Legal Business Name): MITA RAHEJA MD FACC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 BELMONT AVE SUITES 11 AND 12
YOUNGSTOWN OH
44505-1450
US

IV. Provider business mailing address

PO BOX 6855
YOUNGSTOWN OH
44501-6855
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8169
  • Fax: 330-759-8306
Mailing address:
  • Phone: 330-759-8169
  • Fax: 330-759-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35065143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: