Provider Demographics
NPI:1679701155
Name:SAMARTH, AMRUTA (MD)
Entity type:Individual
Prefix:DR
First Name:AMRUTA
Middle Name:
Last Name:SAMARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMRUTA
Other - Middle Name:
Other - Last Name:ASHTEKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13980 BLOSSOM HILL RD
Mailing Address - Street 2:STE B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5121
Mailing Address - Country:US
Mailing Address - Phone:408-445-8400
Mailing Address - Fax:408-445-0875
Practice Address - Street 1:13980 BLOSSOM HILL RD
Practice Address - Street 2:STE B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5121
Practice Address - Country:US
Practice Address - Phone:408-445-8400
Practice Address - Fax:317-963-7068
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140534208100000X
TXBP10034446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000788842OtherANTHEM
IN201093920Medicaid
IN264220003Medicare PIN