Basic Information
| Provider Information | |||||||||
| NPI: | 1104863463 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEHNDIRATTA, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6330 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200150330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014982922 | ||||||||
| FaxNumber: | 3014983074 | ||||||||
| Practice Location | |||||||||
| Address1: | 3411 OLANDWOOD CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019240452 | ||||||||
| FaxNumber: | 3014983074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEHNDIRATTA | ||||||||
| AuthorizedOfficialFirstName: | YASH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3014667485 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084P0800X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | KFT2ME | 01 | MD | GROUP PROVIDER# CAREFIRST | OTHER | J082 | 01 | DC | GROUP PROVIDER# CAREFIRST | OTHER |