Healthcare Provider Details

I. General information

NPI: 1851687362
Provider Name (Legal Business Name): JITESH UMARVADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 RUSSELL DR
LEBANON PA
17042-7485
US

IV. Provider business mailing address

912 RUSSELL DR
LEBANON PA
17042-7485
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-7971
  • Fax:
Mailing address:
  • Phone: 717-272-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101255944
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD459798
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: