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NPI Code Detail

MEDICARE: CHAMPAK M DEDHIA M.D.

MEDICARE:   CHAMPAK M DEDHIA  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD027320EPA

General Provider Information

NPI Number : 1134113798
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAMPAK M DEDHIA M.D.
Provider Business Mailing Address
First Line : PO BOX 60
Second Line :
City : PITTSBURGH
State : PA
Zip : 15230-0060
Country : US
Telephone Number : 412-937-5726
Fax Number :
Provider Business Practice Location Address
First Line : 700 QUINCY AVE
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1724
Country : US
Telephone Number : 570-307-4225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 08/06/2015

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Directions to “ CHAMPAK M DEDHIA M.D.” Practice Location

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