Provider Demographics
NPI:1386871598
Name:MUTHA, PRITESH R (MD, DIPABLM, MPH)
Entity type:Individual
Prefix:DR
First Name:PRITESH
Middle Name:R
Last Name:MUTHA
Suffix:
Gender:M
Credentials:MD, DIPABLM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1512
Mailing Address - Country:US
Mailing Address - Phone:713-704-3450
Mailing Address - Fax:713-704-9938
Practice Address - Street 1:6400 FANNIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1512
Practice Address - Country:US
Practice Address - Phone:713-704-3450
Practice Address - Fax:713-704-9938
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194941207R00000X
VA0101257552207RG0100X
VA390200000X
TXT3831207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program