Healthcare Provider Details

I. General information

NPI: 1255632402
Provider Name (Legal Business Name): HITESH GARG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
US

IV. Provider business mailing address

SHRIENRS HOSPITALS FOR CHILDREN PHILADELPHIA LOCKBOX # 7642 - P.O. BOX 8500
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-430-4026
  • Fax: 215-430-4079
Mailing address:
  • Phone: 215-430-4022
  • Fax: 215-430-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMT198409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: