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General NPI Number Information
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NPI Number | 1124049226
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Entity Type | Individual
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Provider Name | RAGHU MITRA MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 55 HORIZON DR
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City | HUNTINGTON
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State | NY
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Zip | 11743-4436
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Country | US
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Telephone | 631-920-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 16 WINCHESTER DR
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City | GLEN HEAD
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State | NY
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Zip | 11545-3203
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Country | US
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Telephone | 516-626-7780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 119844-1
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License Number State | NY
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