Healthcare Provider Details

I. General information

NPI: 1376553768
Provider Name (Legal Business Name): JOTINDER K. PATHEJA M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2787 WALKER CT
EXPORT PA
15632-9307
US

IV. Provider business mailing address

2787 WALKER CT
EXPORT PA
15632-9307
US

V. Phone/Fax

Practice location:
  • Phone: 724-575-0041
  • Fax:
Mailing address:
  • Phone: 724-575-0041
  • Fax: 724-327-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD038641L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01145450
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JOTINDER K PATHEJA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 724-575-0041