Healthcare Provider Details

I. General information

NPI: 1417989179
Provider Name (Legal Business Name): HRIDAYESH K PATHAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SERVIDEA DR
RIDGWAY PA
15853-6333
US

IV. Provider business mailing address

43 SERVIDEA DR
RIDGWAY PA
15853-6333
US

V. Phone/Fax

Practice location:
  • Phone: 814-776-2145
  • Fax: 814-776-1470
Mailing address:
  • Phone: 814-776-2145
  • Fax: 814-776-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD039418L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: