Basic Information
| Provider Information | |||||||||
| NPI: | 1851742423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CO | ||||||||
| FirstName: | MITA ZAHRA | ||||||||
| MiddleName: | ESTRADA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 825 TOWN CENTER DR STE 152 | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413510 | ||||||||
| FaxNumber: | 7736653401 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 TOWN CENTER DR STE 152 | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413510 | ||||||||
| FaxNumber: | 7736653401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036155939 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A160905 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD475173 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.