Provider Demographics
NPI:1306945167
Name:MITTAL, USHA A (MD)
Entity type:Individual
Prefix:
First Name:USHA
Middle Name:A
Last Name:MITTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEMPLE OF SERVICE, #666
Mailing Address - Street 2:47TH ST. 9TH SECTOR/KKNAGAR
Mailing Address - City:MADRAS
Mailing Address - State:IN
Mailing Address - Zip Code:600078
Mailing Address - Country:IN
Mailing Address - Phone:617-964-7326
Mailing Address - Fax:
Practice Address - Street 1:TEMPLE OF SERVICE, #666
Practice Address - Street 2:47TH ST. 9TH SECTOR/KKNAGAR
Practice Address - City:MADRAS
Practice Address - State:IN
Practice Address - Zip Code:600078
Practice Address - Country:IN
Practice Address - Phone:617-964-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics