Healthcare Provider Details

I. General information

NPI: 1629489182
Provider Name (Legal Business Name): KHUSHPREET CHEEMA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

IV. Provider business mailing address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-0430
  • Fax: 717-763-9854
Mailing address:
  • Phone: 717-763-0430
  • Fax: 717-763-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058905
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: