Healthcare Provider Details

I. General information

NPI: 1992896237
Provider Name (Legal Business Name): PATRICK A. JARVIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER PEDIATRICS 132 ABIGAIL LANE
PORT MATILDA PA
16870
US

IV. Provider business mailing address

GEISINGER PEDIATRICS 132 ABIGAIL LANE
PORT MATILDA PA
16870
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-7100
  • Fax: 814-272-6510
Mailing address:
  • Phone: 814-272-7100
  • Fax: 814-272-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10003850
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC10003850
License Number StateDE

VII. Legacy identifiers

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

# 1
Identifier6706908
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 2
Identifier101045770
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier6398405
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 4
Identifier2115010
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: