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NPI Code Detail

MEDICARE: RAGHU MITRA MD

MEDICARE: RAGHU 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
12084P0800XPsychiatry Physician119844-1NY

General Provider Information

NPI Number : 1124049226
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAGHU MITRA MD
Provider Business Mailing Address
First Line : 16 WINCHESTER DR
Second Line :
City : GLEN HEAD
State : NY
Zip : 11545-3203
Country : US
Telephone Number : 516-626-7780
Fax Number :
Provider Business Practice Location Address
First Line : 55 HORIZON DR
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4436
Country : US
Telephone Number : 631-920-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 12/15/2008

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