Healthcare Provider Details

I. General information

NPI: 1346651163
Provider Name (Legal Business Name): JAHNAVI CHATTERJEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST UMC, DEPARTMENT OF PEDIATRICS
JACKSON MS
39216-4500
US

IV. Provider business mailing address

500 UNIVERSITY DRIVE
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5200
  • Fax: 601-984-2086
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD471573
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: