Basic Information
| Provider Information | |||||||||
| NPI: | 1942445770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEORAS | ||||||||
| FirstName: | MITA | ||||||||
| MiddleName: | SATISH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2008 | ||||||||
| LastUpdateDate: | 08/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.015243 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2084N0400X | 35099698 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0084719 | 05 | OH | MEDICAID |