Provider Demographics
NPI:1962518019
Name:BUDIAMAL, LITA R (MD)
Entity type:Individual
Prefix:DR
First Name:LITA
Middle Name:R
Last Name:BUDIAMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LITA
Other - Middle Name:R
Other - Last Name:BUDIAMAL MATHAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 ELIZABETH PL STE D
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-222-2233
Mailing Address - Fax:937-222-9665
Practice Address - Street 1:1 ELIZABETH PL STE D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-222-2233
Practice Address - Fax:937-222-9665
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048302207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBU0850756OtherMEDICARE PTAN
OH050082013OtherRAILROAD MEDICARE
OH0505402Medicaid
OH000000213070OtherANTHEM
OH0505402Medicaid
OHBU0850755Medicare PIN
OH050082013OtherRAILROAD MEDICARE