Healthcare Provider Details

I. General information

NPI: 1609807296
Provider Name (Legal Business Name): PADMARAO JEVAJI MD, MMPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 NEW CASTLE RD VA MEDICAL CENTER
BUTLER PA
16001-2418
US

IV. Provider business mailing address

7087 BENNINGTON WOODS DR
PITTSBURGH PA
15237-6372
US

V. Phone/Fax

Practice location:
  • Phone: 724-287-4781
  • Fax:
Mailing address:
  • Phone: 412-366-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD062266L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: