MEDICARE: SRIKANTH MITTA 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	321014	NY

General Provider Information

NPI Number	:	1447316708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRIKANTH MITTA MD

Provider Business Mailing Address
First Line	:	665 SARATOGA RD
Second Line	:	SUITE 400
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2134
Country	:	US
Telephone Number	:	518-580-2185
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 SARATOGA RD STE 400
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-1694
Country	:	US
Telephone Number	:	518-580-2185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/20/2023

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