Provider Demographics
NPI:1992064521
Name:BORDIA, RITU (MD)
Entity type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:BORDIA
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:131-796-2383
Mailing Address - Fax:
Practice Address - Street 1:5501 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8513
Practice Address - Country:US
Practice Address - Phone:765-741-2957
Practice Address - Fax:765-747-3310
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01089155A2085N0700X, 2085R0202X
MO20180092022085N0700X
NY2673332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN959090182OtherMEDICARE PTAN
IN300074008Medicaid