Healthcare Provider Details

I. General information

NPI: 1992824320
Provider Name (Legal Business Name): JOTINDER KAUR PATHEJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
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: 724-327-8647
  • Fax: 724-327-8647
Mailing address:
  • Phone: 724-327-8647
  • Fax: 724-327-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD038641L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierMD038641L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: