Healthcare Provider Details

I. General information

NPI: 1407825417
Provider Name (Legal Business Name): PRATIBHA V VAKHARIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N LOGAN BLVD
BURNHAM PA
17009-1816
US

IV. Provider business mailing address

PO BOX 99
BURNHAM PA
17009-0099
US

V. Phone/Fax

Practice location:
  • Phone: 717-248-9550
  • Fax: 717-248-9558
Mailing address:
  • Phone: 717-248-9550
  • Fax: 717-248-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD040650E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD-040650-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: